scholarly journals Influence of N-acetylcysteine on chronic bronchitis or COPD exacerbations: a meta-analysis

2015 ◽  
Vol 24 (137) ◽  
pp. 451-461 ◽  
Author(s):  
Mario Cazzola ◽  
Luigino Calzetta ◽  
Clive Page ◽  
Josè Jardim ◽  
Alexander G. Chuchalin ◽  
...  
Keyword(s):  
Relative Risk ◽  
Airway Obstruction ◽  
Chronic Bronchitis ◽  
Meta Analysis ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Regular Treatment ◽  
Copd Exacerbations ◽  
Copd Patients ◽  
High Doses

In order to clarify the possible role of N-acetylcysteine (NAC) in the treatment of patients with chronic bronchitis and chronic obstructive pulmonary disease (COPD), we have carried out a meta-analysis testing the available evidence that NAC treatment may be effective in preventing exacerbations of chronic bronchitis or COPD and evaluating whether there is a substantial difference between the responses induced by low (≤600 mg per day) and high (>600 mg per day) doses of NAC.The results of the present meta-analysis (13 studies, 4155 COPD patients, NAC n=1933; placebo or controls n=2222) showed that patients treated with NAC had significantly and consistently fewer exacerbations of chronic bronchitis or COPD (relative risk 0.75, 95% CI 0.66–0.84; p<0.01), although this protective effect was more apparent in patients without evidence of airway obstruction. However, high doses of NAC were also effective in patients suffering from COPD diagnosed using spirometric criteria (relative risk 0.75, 95% CI 0.68–0.82; p=0.04). NAC was well tolerated and the risk of adverse reactions was not dose-dependent (low doses relative risk 0.93, 95% CI 0.89–0.97; p=0.40; high doses relative risk 1.11, 95% CI 0.89–1.39; p=0.58).The strong signal that comes from this meta-analysis leads us to state that if a patient suffering from chronic bronchitis presents a documented airway obstruction, NAC should be administered at a dose of ≥1200 mg per day to prevent exacerbations, while if a patient suffers from chronic bronchitis, but is without airway obstruction, a regular treatment of 600 mg per day seems to be sufficient.

scholarly journals LABA/LAMA fixed-dose combinations versus LAMA monotherapy in the prevention of COPD exacerbations: a systematic review and meta-analysis

2020 ◽  
Vol 14 ◽  
pp. 175346662093719
Author(s):  
Ching-Yi Chen ◽  
Wang-Chun Chen ◽  
Chi-Hsien Huang ◽  
Yi-Ping Hsiang ◽  
Chau-Chyun Sheu ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Similar Efficacy ◽  
Fixed Dose ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Copd Patients ◽  
History Of ◽  
Long Acting

Background: Long-acting muscarinic antagonist (LAMA) monotherapy is recommended for chronic obstructive pulmonary disease (COPD) patients with high risk of exacerbations. It is unclear whether long-acting β2-agonist (LABA)/LAMA fixed-dose combinations (FDCs) are more effective than LAMAs alone in preventing exacerbations. The aim of this study was to systematically review the literature to investigate whether LABA/LAMA FDCs are more effective than LAMA monotherapy in preventing exacerbations. Methods: We searched several databases and manufacturers’ websites to identify relevant randomized clinical trials comparing LABA/LAMA FDC treatment with LAMAs alone ⩾24 weeks. Outcomes of interest were time to first exacerbation and rates of moderate to severe, severe and all exacerbations. Results: We included 10 trials in 9 articles from 2013 to 2018 with a total of 19,369 patients for analysis in this study. Compared with LAMA monotherapy, LABA/LAMA FDCs demonstrated similar efficacy in terms of time to first exacerbation [hazard ratio, 0.96; 95% confidence interval (CI) 0.79–1.18; p = 0.71], moderate to severe exacerbations [risk ratio (RR), 0.96; 95% CI 0.90–1.03; p = 0.28], severe exacerbations (RR, 0.92; 95% CI 0.81–1.03; p = 0.15), and a marginal superiority in terms of all exacerbations (RR, 0.92; 95% CI 0.86–1.00; p = 0.04). The incidence of all exacerbation events was lower in the LABA/LAMA FDC group for the COPD patients with a history of previous exacerbations and those with a longer treatment period (52–64 weeks). Conclusion: This study provides evidence that LABA/LAMA FDCs are marginally superior in the prevention of all exacerbations compared with LAMA monotherapy in patients with COPD. The reviews of this paper are available via the supplemental material section.

scholarly journals The characteristics of the frequent exacerbator with chronic bronchitis phenotype and non-exacerbator phenotype in patients with chronic obstructive pulmonary disease: a meta-analysis and system review

2020 ◽  
Author(s):  
Jianjun Wu ◽  
Hong-ri Xu ◽  
Ying-xue Zhang ◽  
Yi-xuan Li ◽  
Hui-yong Yu ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Bronchitis ◽  
Pulmonary Disease ◽  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Meta Analysis ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

Abstract Objective: To investigate the clinical characteristics between the frequent exacerbator with chronic bronchitis (FE-CB) phenotype and the non-exacerbator (NE) phenotype among patients with chronic obstructive pulmonary disease (COPD). Methods: We searched CNKI, Wan fang, Chongqing VIP, China Biology Medicine disc, PubMed, Cochrane Library, and EMBASE databases for relevant studies published as of April 30, 2019. All studies that investigated COPD patients with the FE-CB and NE phenotypes and which qualified the inclusion criteria were included. Cross-Sectional/Prevalence Study Quality recommendations were used to measure methodological quality. RevMan5.3 software was used for meta-analysis. Results: Ten case-control studies (n=8848) were included. Compared with the NE phenotype, patients with the FE-CB phenotype showed significantly lower forced vital capacity percent predicted (FVC%pred) [mean difference (MD) -6.69, 95% confidence interval (CI) -7.73–-5.65, P<0.001, I2=5%], forced expiratory volume in one second percent predicted (FEV1%pred) (MD -8.50, 95% CI -11.36–-5.65, P<0.001, I2=91%), and forced expiratory volume in one second/forced vital capacity (FEV1/FVC) (MD -3.76, 95% CI -4.58–-2.95,P<0.001, I2=0%); in contrast, the quantity of cigarettes smoked (pack-years) (MD 3.09, 95% CI 1.60–4.58, P<0.001, I2=41%), COPD assessment test (CAT) score (MD 5.61, 95% CI 4.62–6.60, P<0.001, I2=80%), modified Medical British Research Council (mMRC) score (MD 0.72, 95% CI 0.63–0.82, P<0.001, I2=57%), exacerbations in previous year (2.65, 95% CI 2.32–2.97, P<0.001, I2=91%), body mass index (BMI), obstruction, dyspnea, exacerbations (BODEx) (MD 1.78, 95% CI 1.28–2.28, P<0.001, I2=91%), I2=34%), and Charlson comorbidity index (MD 0.47, 95% CI 0.37–0.58, P<0.001, I2=0] were significantly higher in patients with FE-CB phenotype. No significant between-group difference was observed with respect to BMI (MD-0.14, 95% CI -0.70–0.42, P=0.62, I2=75%). Conclusion: COPD patients with the FE-CB phenotype had poorer pulmonary function and higher CAT score, the quantity of cigarettes smoked (pack-years), frequency of acute exacerbations, and mMRC scores than those with the NE phenotype.

scholarly journals The characteristics of the frequent exacerbator with chronic bronchitis phenotype and non-exacerbator phenotype in patients with chronic obstructive pulmonary disease: a meta-analysis and system review

2020 ◽  
Author(s):  
jianjun wu ◽  
Hong-ri Xu ◽  
Ying-xue Zhang ◽  
Yi-xuan Li ◽  
Hui-yong Yu ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Bronchitis ◽  
Pulmonary Disease ◽  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Meta Analysis ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

Abstract Objective: To investigate the clinical characteristics between the frequent exacerbator with chronic bronchitis (FE-CB) phenotype and the non-exacerbator (NE) phenotype among patients with chronic obstructive pulmonary disease (COPD). Methods: We searched CNKI, Wan fang, Chongqing VIP, China Biology Medicine disc, PubMed, Cochrane Library, and EMBASE databases for relevant studies published as of April 30, 2019. All studies that investigated COPD patients with the FE-CB and NE phenotypes and which qualified the inclusion criteria were included. Cross-Sectional/Prevalence Study Quality recommendations were used to measure methodological quality. RevMan5.3 software was used for meta-analysis. Results: Ten case-control studies (n=8848) were included. Compared with the NE phenotype, patients with the FE-CB phenotype showed significantly lower forced vital capacity percent predicted (FVC%pred) [mean difference (MD) -6.69, 95% confidence interval (CI) -7.73–-5.65, P<0.001, I2=5%], forced expiratory volume in one second percent predicted (FEV1%pred) (MD -8.50, 95% CI -11.36–-5.65, P<0.001, I2=91%), and forced expiratory volume in one second/forced vital capacity (FEV1/FVC) (MD -3.76, 95% CI -4.58–-2.95,P<0.001, I2=0%); in contrast, the quantity of cigarettes smoked (pack-years) (MD 3.09, 95% CI 1.60–4.58, P<0.001, I2=41%), COPD assessment test (CAT) score (MD 5.61, 95% CI 4.62–6.60, P<0.001, I2=80%), modified Medical British Research Council (mMRC) score (MD 0.72, 95% CI 0.63–0.82, P<0.001, I2=57%), exacerbations in previous year (2.65, 95% CI 2.32–2.97, P<0.001, I2=91%), body mass index (BMI), obstruction, dyspnea, exacerbations (BODEx) (MD 1.78, 95% CI 1.28–2.28, P<0.001, I2=91%), I2=34%), and Charlson comorbidity index (MD 0.47, 95% CI 0.37–0.58, P<0.001, I2=0] were significantly higher in patients with FE-CB phenotype. No significant between-group difference was observed with respect to BMI (MD-0.14, 95% CI -0.70–0.42, P=0.62, I2=75%). Conclusion: COPD patients with the FE-CB phenotype had poorer pulmonary function and higher CAT score, the quantity of cigarettes smoked (pack-years), frequency of acute exacerbations, and mMRC scores than those with the NE phenotype.

scholarly journals The characteristics of the frequent exacerbator with chronic bronchitis phenotype and non-exacerbator phenotype in patients with chronic obstructive pulmonary disease: a meta-analysis and system review

2019 ◽  
Author(s):  
jianjun wu ◽  
Hong-ri Xu ◽  
Ying-xue Zhang ◽  
Yi-xuan Li ◽  
Hui-yong Yu ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Bronchitis ◽  
Pulmonary Disease ◽  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Meta Analysis ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

Abstract Abstract Objective: To investigate the clinical characteristics between the frequent exacerbator with chronic bronchitis (FE-CB) phenotype and the non-exacerbator (NE) phenotype among patients with chronic obstructive pulmonary disease (COPD). Methods: We searched CNKI, Wan fang, Chongqing VIP, China Biology Medicine disc, PubMed, Cochrane Library, and EMBASE databases for relevant studies published as of April 30, 2019. All studies that investigated COPD patients with the FE-CB and NE phenotypes and which qualified the inclusion criteria were included. Cross-Sectional/Prevalence Study Quality recommendations were used to measure methodological quality. RevMan5.3 software was used for meta-analysis. Results: Ten case-control studies (n=8848) were included. Compared with the NE phenotype, patients with the FE-CB phenotype showed significantly lower forced vital capacity percent predicted (FVC%pred) [mean difference (MD) -6.69, 95% confidence interval (CI) -7.73–-5.65, P<0.001, I2=5%], forced expiratory volume in one second percent predicted (FEV1%pred) (MD -8.50, 95% CI -11.36–-5.65, P<0.001, I2=91%), and forced expiratory volume in one second/forced vital capacity (FEV1/FVC) (MD -3.76, 95% CI -4.58–-2.95,P<0.001, I2=0%); in contrast, the quantity of cigarettes smoked (pack-years) (MD 3.09, 95% CI 1.60–4.58, P<0.001, I2=41%), COPD assessment test (CAT) score (MD 5.61, 95% CI 4.62–6.60, P<0.001, I2=80%), modified Medical British Research Council (mMRC) score (MD 0.72, 95% CI 0.63–0.82, P<0.001, I2=57%), exacerbations in previous year (2.65, 95% CI 2.32–2.97, P<0.001, I2=91%), body mass index (BMI), obstruction, dyspnea, exacerbations (BODEx) (MD 1.78, 95% CI 1.28–2.28, P<0.001, I2=91%), I2=34%), and Charlson comorbidity index (MD 0.47, 95% CI 0.37–0.58, P<0.001, I2=0] were significantly higher in patients with FE-CB phenotype. No significant between-group difference was observed with respect to BMI (MD-0.14, 95% CI -0.70–0.42, P=0.62, I2=75%). Conclusion: COPD patients with the FE-CB phenotype had poorer pulmonary function and higher CAT score, the quantity of cigarettes smoked (pack-years), frequency of acute exacerbations, and mMRC scores than those with the NE phenotype.

scholarly journals The characteristics of the frequent exacerbator with chronic bronchitis phenotype and non-exacerbator phenotype in patients with chronic obstructive pulmonary disease: a meta-analysis and system review

2020 ◽  
Author(s):  
Jianjun Wu ◽  
Hong-ri Xu ◽  
Ying-xue Zhang ◽  
Yi-xuan Li ◽  
Hui-yong Yu ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Chronic Bronchitis ◽  
Pulmonary Disease ◽  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Meta Analysis ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients

Abstract Objective: To investigate the clinical characteristics between the frequent exacerbator with chronic bronchitis (FE-CB) phenotype and the non-exacerbator (NE) phenotype among patients with chronic obstructive pulmonary disease (COPD). Methods: We searched CNKI, Wan fang, Chongqing VIP, China Biology Medicine disc, PubMed, Cochrane Library, and EMBASE databases for relevant studies published as of April 30, 2019. All studies that investigated COPD patients with the FE-CB and NE phenotypes and which qualified the inclusion criteria were included. Cross-Sectional/Prevalence Study Quality recommendations were used to measure methodological quality. RevMan5.3 software was used for meta-analysis. Results: Ten case-control studies (n=8848) were included. Compared with the NE phenotype, patients with the FE-CB phenotype showed significantly lower forced vital capacity percent predicted (FVC%pred) [mean difference (MD) -6.69, 95% confidence interval (CI) -7.73–-5.65, P<0.001, I2=5%], forced expiratory volume in one second percent predicted (FEV1%pred) (MD -8.50, 95% CI -11.36–-5.65, P<0.001, I2=91%), and forced expiratory volume in one second/forced vital capacity (FEV1/FVC) (MD -3.76, 95% CI -4.58–-2.95,P<0.001, I2=0%); in contrast, the quantity of cigarettes smoked (pack-years) (MD 3.09, 95% CI 1.60–4.58, P<0.001, I2=41%), COPD assessment test (CAT) score (MD 5.61, 95% CI 4.62–6.60, P<0.001, I2=80%), modified Medical British Research Council (mMRC) score (MD 0.72, 95% CI 0.63–0.82, P<0.001, I2=57%), exacerbations in previous year (2.65, 95% CI 2.32–2.97, P<0.001, I2=91%), body mass index (BMI), obstruction, dyspnea, exacerbations (BODEx) (MD 1.78, 95% CI 1.28–2.28, P<0.001, I2=91%), I2=34%), and Charlson comorbidity index (MD 0.47, 95% CI 0.37–0.58, P<0.001, I2=0] were significantly higher in patients with FE-CB phenotype. No significant between-group difference was observed with respect to BMI (MD-0.14, 95% CI -0.70–0.42, P=0.62, I2=75%). Conclusion: COPD patients with the FE-CB phenotype had poorer pulmonary function and higher CAT score, the quantity of cigarettes smoked (pack-years), frequency of acute exacerbations, and mMRC scores than those with the NE phenotype.

scholarly journals Blood eosinophil count-guided corticosteroid therapy and as a prognostic biomarker of exacerbations of chronic obstructive pulmonary disease: a systematic review and meta-analysis

2021 ◽  
Vol 12 ◽  
pp. 204062232110287
Author(s):  
Tao Liu ◽  
Zi-Jian Xiang ◽  
Xiao-Meng Hou ◽  
Jing-Jing Chai ◽  
Yan-Li Yang ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Prognostic Biomarker ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
The Stability

Background: Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and dyspnea, as well as an increase in the number of leukocytes in the airways, lungs, and pulmonary vessels. A ‘One size fits all’ approach to COPD patients with different clinical features may be considered outdated. The following are the two major objectives of this meta-analysis: the first is to determine if blood eosinophil counts (BEC) can serve as a prognostic biomarker of COPD outcomes, and the second is to determine which level of BEC is effective for inhaled corticosteroid (ICS) treatment. Methods: We searched articles published before 15 May 2021 in the following four electronic databases: Web of Science, Cochrane Library, EMBASE, and PubMed. Results: A total of 42 studies, comprising a sampling of 188,710 subjects, were summarized and compared in this meta-analysis. The rate ratio (RR) of exacerbations of COPD (ECOPD) between ICS and non-ICS treatment was statistically significant for the COPD patients with a baseline BEC ⩾ 2% or ⩾ 200 cells/μl, RR = 0.82 (0.73, 0.93) or 0.79 (0.70, 0.89) respectively, while the RR of ECOPD between ICS and non-ICS treatment was statistically insignificant for the COPD patients with baseline BEC < 2% or <200 cells/μl, RR = 0.97 (0.87, 1.08) or 0.97 (0.86, 1.08), suggested that ICS therapy was beneficial to the improvement of ECOPD in patients with a baseline BEC ⩾ 2% or BEC ⩾ 200 cells/μl. Conclusion: Our research shows that a BEC ⩾ 200 cells/μl or ⩾2% is likely to become the cutoff value of ICS treatment for ECOPD. Moreover, we believe that the baseline BEC can be used as a biomarker for predicting ECOPD. The stability of BEC requires special attention.

scholarly journals Serum Albumin Concentrations in Stable Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (2) ◽  
pp. 269
Author(s):  
Elisabetta Zinellu ◽  
Alessandro G. Fois ◽  
Elisabetta Sotgiu ◽  
Sabrina Mellino ◽  
Arduino A. Mangoni ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Obstructive Pulmonary Disease ◽  
Serum Albumin ◽  
Pulmonary Disease ◽  
Meta Analysis ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Standard Mean Difference ◽  
Copd Patients

Background: Chronic obstructive pulmonary disease (COPD) is a progressive condition characterized by chronic airway inflammation and lung parenchyma damage. Systemic inflammation and oxidative stress also play a role in the pathogenesis of COPD. Serum albumin is a negative acute-phase protein with antioxidant effects and an important marker of malnutrition. The aim of this meta-analysis was to investigate differences in serum albumin concentrations between patients with stable COPD and non-COPD subjects. Methods: A systematic search was conducted, using the terms “albumin” and “chronic obstructive pulmonary disease” or “COPD”, in the electronic databases PubMed and Web of Science, from inception to May 2020. Results: Twenty-six studies were identified on a total of 2554 COPD patients and 2055 non-COPD controls. Pooled results showed that serum albumin concentrations were significantly lower in COPD patients (standard mean difference, SMD = −0.50, 95% CI −0.67 to −0.32; p < 0.001). No significant differences were observed in SMD of serum albumin concentrations between COPD patients with forced expiratory volume in the 1st second (FEV1) < 50% and those with FEV1 > 50%. Conclusions: Our systematic review and meta-analysis showed that serum albumin concentrations are significantly lower in patients with stable COPD compared to non-COPD controls. This supports the presence of a deficit in systemic anti-inflammatory and antioxidant defense mechanisms in COPD.

scholarly journals Domiciliary Cough Monitoring for the Prediction of COPD Exacerbations

Lung ◽  
2021 ◽  
Vol 199 (2) ◽  
pp. 131-137
Author(s):  
Michael G. Crooks ◽  
Albertus C. den Brinker ◽  
Susannah Thackray-Nocera ◽  
Ralph van Dinther ◽  
Caroline E. Wright ◽  
...  
Keyword(s):  
Automated System ◽  
Chronic Obstructive ◽  
Service Utilisation ◽  
Alert System ◽  
Obstructive Pulmonary Disease ◽  
Prospective Longitudinal Study ◽  
Copd Exacerbations ◽  
Cough Frequency ◽  
Copd Patients ◽  
Prospective Longitudinal

Abstract Introduction Acute exacerbations of COPD (AE-COPD) are a leading cause of health service utilisation and are associated with morbidity and mortality. Identifying the prodrome of AE-COPD by monitoring symptoms and physiological parameters (telemonitoring) has proven disappointing and false alerts limit clinical utility. We report objective monitoring of cough counts around AE-COPD and the performance of a novel alert system identifying meaningful change in cough frequency. Methods This prospective longitudinal study of cough monitoring included chronic obstructive pulmonary disease (COPD) patients experienced in telemonitoring that had two or more AE-COPD in the past year. Participants underwent cough monitoring and completed a daily questionnaire for 90 days. The automated system identified deteriorating trends in cough and this was compared with alerts generated by an established telemonitoring questionnaire. Results 28 patients [median age 66 (range 46–86), mean FEV-1% predicted 36% (SD 18%)] completed the study and had a total of 58 exacerbations (43 moderate and 15 severe). Alerts based on cough monitoring were generated mean 3.4 days before 45% of AE-COPD with one false alert every 100 days. In contrast, questionnaire-based alerts occurred in the prodrome of 88% of AE-COPD with one false alert every 10 days. Conclusion An alert system based on cough frequency alone predicted 45% AE-COPD; the low false alert rate with cough monitoring suggests it is a practical and clinically relevant tool. In contrast, the utility of questionnaire-based symptom monitoring is limited by frequent false alerts.

scholarly journals Periodontal Health and Chronic Obstructive Pulmonary Disease (COPD) Exacerbations: A Systematic Review

2021 ◽  
Author(s):  
Niamh Kelly ◽  
Lewis Winning ◽  
Christopher Irwin ◽  
Fionnuala Lundy ◽  
Dermot Linden ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Chronic Obstructive Pulmonary Disease ◽  
Risk Of Bias ◽  
Chronic Obstructive ◽  
Periodontal Health ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Copd Patients

Abstract BackgroundA growing body of evidence suggests a role for oral bacteria in lung infections. This systematic review aimed to analyse the association between poor periodontal health and the frequency of chronic obstructive pulmonary disease (COPD) exacerbations. MethodsPubMed, Embase, Web of Science, CINAHL and Medline were searched for studies published until May 2020, with no language restriction. Studies reporting periodontal condition, or periodontal treatment outcomes, with data on the frequency of exacerbations of COPD, were identified. The primary outcome was the frequency of exacerbations and secondary outcomes included quality of life and hospitalisation. Studies were assessed for eligibility and quality by two assessors independently.Results Searches identified 532 records and 8 met the inclusion criteria. The data from intervention studies showed reduction in the frequency of exacerbations following periodontal treatment. Data from observational studies suggest association of worse plaque scores with exacerbation but not pocket depth or clinical attachment loss. Better periodontal health was also associated with reduced frequency of COPD exacerbations, hospitalisations and improved quality of life in COPD patients. Due to the high heterogeneity no meta-analysis was performed. The quality of some of the included studies was low and there was evidence of high risk of bias.ConclusionThe data supports possible association between poor periodontal health, the frequency of exacerbations and quality of life in COPD patients. The evidence is limited by high risk of bias suggesting need for well-designed and adequately powered randomised control trials.The PROSPERO registration number CRD42020180328

scholarly journals Bronchoalveolar Lavage Fluid from COPD Patients Reveals More Compounds Associated with Disease than Matched Plasma

Metabolites ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. 157 ◽  
Author(s):  
Eitan Halper-Stromberg ◽  
Lucas Gillenwater ◽  
Charmion Cruickshank-Quinn ◽  
Wanda Kay O’Neal ◽  
Nichole Reisdorph ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Cell Metabolism ◽  
Lavage Fluid ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
False Discovery ◽  
Copd Patients ◽  
Clinical Covariates

Smoking causes chronic obstructive pulmonary disease (COPD). Though recent studies identified a COPD metabolomic signature in blood, no large studies examine the metabolome in bronchoalveolar lavage (BAL) fluid, a more direct representation of lung cell metabolism. We performed untargeted liquid chromatography–mass spectrometry (LC–MS) on BAL and matched plasma from 115 subjects from the SPIROMICS cohort. Regression was performed with COPD phenotypes as the outcome and metabolites as the predictor, adjusted for clinical covariates and false discovery rate. Weighted gene co-expression network analysis (WGCNA) grouped metabolites into modules which were then associated with phenotypes. K-means clustering grouped similar subjects. We detected 7939 and 10,561 compounds in BAL and paired plasma samples, respectively. FEV1/FVC (Forced Expiratory Volume in One Second/Forced Vital Capacity) ratio, emphysema, FEV1 % predicted, and COPD exacerbations associated with 1230, 792, eight, and one BAL compounds, respectively. Only two plasma compounds associated with a COPD phenotype (emphysema). Three BAL co-expression modules associated with FEV1/FVC and emphysema. K-means BAL metabolomic signature clustering identified two groups, one with more airway obstruction (34% of subjects, median FEV1/FVC 0.67), one with less (66% of subjects, median FEV1/FVC 0.77; p < 2 × 10−4). Associations between metabolites and COPD phenotypes are more robustly represented in BAL compared to plasma.

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