MULTI-PHACET - MULTIdimensional clinical phenotyping of hospitalised acute COPD ExacerbaTions

BackgroundThe generic term “exacerbation” does not reflect the heterogeneity of acute exacerbations of COPD (AECOPD). We utilised a novel algorithmic strategy to profile exacerbation phenotypes based on underlying aetiologies.MethodsPatients hospitalised for AECOPD (n=146) were investigated for aetiological contributors summarised in a mnemonic acronym ABCDEFGX (A=Airway virus, B=Bacterial, C=Coinfection, D=Depression/anxiety, E=Eosinophils, F=Failure (cardiac), G=General environment, X=Unknown). Results from clinical investigations were combined to construct AECOPD phenotypes. Relationships to clinical outcomes were examined for both composite phenotypes and their specific aetiological components. Aetiologies identified at exacerbation were reassessed at outpatient follow-up.ResultsHospitalised AECOPDs were remarkably diverse, with 26 distinct phenotypes identified. Multiple aetiologies were common (70%) and unidentifiable aetiology rare (4.1%). If viruses were detected (29.5%), patients had longer hospitalisation (7.7±5.6 versus 6.0±3.9 days, p=0.03) despite fewer “frequent exacerbators” (9.3% versus 37%, p=0.001) and lower mortality at 1 year (p=0.03). If bacterial infection was found (40.4%), patients were commonly “frequent exacerbators” (44% versus 18.4%, p=0.001). Eosinophilic exacerbations (28%) were associated with lower pH (7.32±0.06 versus 7.36±0.09, p=0.04), higher PvCO2 (53.7±10.5 versus 48.8±12.8, p=0.04), greater NIV usage (34.1% versus 18.1%) but shorter hospitalisation (4[3–5] versus 6[4–9] days, p<0.001) and lower infection rates (41.4% versus 80.9%, p<0.0001). Cardiac dysfunction and severe anxiety/depression were common in both infective and non-infective exacerbations. Characteristics identified at exacerbation often persisted after recovery.ConclusionsHospitalised AECOPDs have numerous causes, often in combination, that converge in complex, multi-faceted phenotypes. Clinically important differences in outcomes suggest that a phenotyping strategy based on aetiologies can enhance AECOPD management.

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Prognostic Value of Oxygenated Hemoglobin Assessed during Acute Exacerbations of Chronic Pulmonary Disease

Respiration ◽

10.1159/000513440 ◽

2021 ◽

pp. 1-8

Author(s):

Clemens F. Hinke ◽

Rudolf A. Jörres ◽

Peter Alter ◽

Robert Bals ◽

Florian Bornitz ◽

...

Keyword(s):

Pulmonary Disease ◽

Predictive Value ◽

Hemoglobin Concentration ◽

Blood Gas Analysis ◽

Study Data ◽

Gas Analysis ◽

Chronic Obstructive ◽

Acute Exacerbations ◽

All Cause Mortality

Background: Oxygenated hemoglobin(OxyHem) is a simple-to-measure marker of oxygen content capable of predicting all-cause mortality in stable chronic obstructive pulmonary disease (COPD). Objectives: We aimed to analyze its predictive value during acute exacerbations of COPD (AECOPD). Methods: In this retrospective study, data from 227 patients discharged after severe AECOPD at RoMed Clinical Center Rosenheim, Germany, between January 2012 and March 2018, was analyzed. OxyHem (hemoglobin concentration [Hb] × fractional SpO2, g/dL) was calculated from oxygen saturation measured by pulse oximetry and hemoglobin assessed within 24 h after admission. The follow-up (1.7 ± 1.5 years) covered all-cause mortality, including readmissions for severe AECOPD. Results: During the follow-up period, 127 patients died, 56 due to AECOPD and 71 due to other reasons. Survivors and non-survivors showed differences in age, FVC % predicted, C-reactive protein, hemoglobin, Cr, Charlson Comorbidity Index (CCI), and OxyHem (p < 0.05 each). Significant independent predictors of survival were BMI, Cr or CCI, FEV1 % predicted or FVC % predicted, Hb, or OxyHem. The predictive value of OxyHem (p = 0.006) was superior to that of Hb or SpO2 and independent of oxygen supply during blood gas analysis. OxyHem was also predictive when using a cutoff value of 12.1 g/dL identified via receiver operating characteristic curves in analyses including either the CCI (hazard ratio 1.85; 95% CI 1.20, 2.84; p = 0.005) or Cr (2.04; 95% CI 1.35, 3.10; p = 0.001) as covariates. Conclusion: The concentration of OxyHem provides independent, easy-to-assess information on long-term mortality risk in COPD, even if measured during acute exacerbations. It therefore seems worth to be considered for broader clinical use.

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Anxiety, Depression, and Post-traumatic Stress a month after 2019 Cyclone Fani in Odisha, India

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.368 ◽

2021 ◽

pp. 1-8

Author(s):

Nilamadhab Kar ◽

Narendra Nath Samantaray ◽

Shreyan Kar ◽

Brajaballav Kar

Keyword(s):

Traumatic Stress ◽

Severe Depression ◽

Considerable Proportion ◽

Post Traumatic Stress ◽

Disaster Victims ◽

Stress Symptoms ◽

Short Period ◽

Post Traumatic ◽

Anxiety Depression ◽

Severe Anxiety

Abstract Background: Early Identification of disaster victims with mental health problems may be useful, but information within a short period after a disaster is scarce in developing countries. This study examined anxiety, depression, and post-traumatic stress symptoms at 1 month following 2019 Cyclone Fani in Odisha, India. Method: Post-traumatic stress symptoms (PTSS) were assessed by the Primary care PTSD screen for DSM 5 (PC-PTSD-5), anxiety symptoms by the Generalised Anxiety Disorder (GAD-7), and depression by the Patient Health Questionnaire (PHQ-9). The survey included participants’ disaster experience e.g., evacuation, fear of death, injury, death in family, damage to house, difficulty for food, displacement, and effect on livelihood. Results: Proportion of sample (n = 80) with probable PTSD was 42.9%, with severe anxiety was 36.7%, moderately severe depression was 16.5%, and severe depression was 3.8%. Suicidal cognitions were reported to increase by 14%. Comorbidity was common; with significant (P < 0.01) correlation between PTSS and anxiety (r = 0.69), depression (r = 0.596), and between anxiety and depression (r = 0.63). Damage of house and displacement were associated significantly with PTSD; evacuation and displacement with moderate and severe depression; and displacement with severe anxiety. No specific demographic factors were significantly linked to the psychiatric morbidities. Conclusion: A considerable proportion of victims had psychiatric morbidities at 1 month. Associated risk factors included housing damages, evacuation, and displacement, suggesting the need to improve the disaster-management process.

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Z-score neurofeedback, heart rate variability biofeedback, and brain coaching for older adults with memory concerns

Restorative Neurology and Neuroscience ◽

10.3233/rnn-201053 ◽

2020 ◽

pp. 1-29

Author(s):

Kyle D. Meeuwsen ◽

Kayleah M. Groeneveld ◽

Linda A. Walker ◽

Anna M. Mennenga ◽

Rachel K. Tittle ◽

...

Keyword(s):

Quality Of Life ◽

Boot Camp ◽

Relative Power ◽

Z Score ◽

Subjective Memory Complaints ◽

Subjective Memory ◽

Memory Complaints ◽

Anxiety Depression

Background: The three-month, multidomain Memory Boot Camp program incorporates z-score neurofeedback (NFB), heart rate variability (HRV) biofeedback, and one-on-one coaching to teach memory skills and encourage behavior change in diet, sleep, physical fitness, and stress reduction. Objective: This prospective trial evaluates the Memory Boot Camp program for adults ages 55 to 85 with symptoms of Mild Cognitive Impairment (MCI) and subjective memory complaints. Methods: Participants were evaluated via the Montreal Cognitive Assessment (MoCA), NeuroTrax Global Cognitive Index, measures of anxiety, depression, sleep, quality of life, quantitative electroencephalography (QEEG), and HRV parameters at four timepoints: baseline, pre-program, post-program, and follow-up. The trial included a three-month waiting period between baseline and pre-program, such that each participant acted as their own control, and follow-up took place six months after completion of the program. Results: Participants’ MoCA scores and self-reported measures of anxiety, depression, sleep quality, and quality of life improved after treatment, and these changes were maintained at follow-up. Physiological changes in HRV parameters after treatment were not significant, however, breathing rate and QEEG parameters were improved at post-program and maintained at follow-up. Finally, participants’ improvement in MoCA score over the treatment period was correlated with their improvement in two brain oscillation parameters targeted by the z-score NFB protocol: relative power of delta and relative power of theta. Conclusions: Trial results suggest that the Memory Boot Camp program is a promising treatment strategy for older adults with symptoms of MCI and subjective memory complaints.

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COVID-19 public health measures: a reduction in hospital admissions for COPD exacerbations

Thorax ◽

10.1136/thoraxjnl-2020-216083 ◽

2020 ◽

pp. thoraxjnl-2020-216083

Author(s):

Jing Yuan Tan ◽

Edwin Philip Conceicao ◽

Liang En Wee ◽

Xiang Ying Jean Sim ◽

Indumathi Venkatachalam

Keyword(s):

Public Health ◽

Clinical Outcomes ◽

Hospital Admissions ◽

Viral Infections ◽

Significant Morbidity ◽

Common Cause ◽

Copd Exacerbations ◽

Health Measures ◽

Acute Exacerbations ◽

Respiratory Viral Infections

Hospitalisations for acute exacerbations of COPD (AECOPD) carry significant morbidity and mortality. Respiratory viral infections (RVIs) are the most common cause of AECOPD and are associated with worse clinical outcomes. During the COVID-19 pandemic, public health measures, such as social distancing and universal masking, were originally implemented to reduce transmission of SARS-CoV-2; these public health measures were subsequently also observed to reduce transmission of other common circulating RVIs. In this study, we report a significant and sustained decrease in hospital admissions for all AECOPD as well as RVI-associated AECOPD, which coincided with the introduction of public health measures during the COVID-19 pandemic.

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GOLD severity stratification and risk of hospitalisation for COPD exacerbations

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2008.378 ◽

2016 ◽

Vol 70 (4) ◽

Cited By ~ 1

Author(s):

M. Lusuardi ◽

C. Lucioni ◽

F. De Benedetto ◽

S. Mazzi ◽

C.M. Sanguinetti ◽

...

Keyword(s):

Clinical Factors ◽

Copd Exacerbations ◽

Telephone Interviews ◽

Function Classes ◽

Prospective Multicentre Study ◽

Relative Risks ◽

Gold Stage ◽

Copd Patients ◽

Oral Corticosteroids

Background and Aim. The Italian Costs for Exacerbations in COPD (“ICE”) study, following a pharmacoeconomic assessment of costs due to COPD exacerbations (primary endpoint), aimed also at evaluating (secondary endpoint) which clinical factors, among those considered for cost-analysis, may, at follow up, present a risk of new exacerbations and re-admission to hospital. Materials and methods. A prospective, multicentre study was carried out on COPD patients admitted to 25 Hospital Centres as a result of an exacerbation from October- December 2002. Following discharge, a 6-month follow- up was performed in each patient via three bi-monthly telephone interviews with a questionnaire administered by an investigator clinician. Results. 570 patients were eligible for data processing, mean age 70.6 years (± 9.5 standard deviation, SD), males 69.2%. According to GOLD, severity stratification was as follows: moderate 36.4%; severe 31.3%; very severe 32.3%. 282 patients experienced at least one exacerbation at follow up, 42% of exacerbations requiring hospitalisation. No significant association was seen between exacerbations and GOLD stage or co-morbidities or treatments except LTOT. Conversely, COPD functional severity influenced hospitalisations very significantly, with relative risks 2.6 (95% Confidence Interval, CI 1.8-3.8) and 2.0 (CI 1.3-2.8) (GOLD very severe versus moderate and severe, respectively), and 1.3 (CI 0.85-2.1) (GOLD severe versus moderate). Hospitalisations were also significantly associated with treatments denoting more severe conditions (oral corticosteroids, oral theophylline, and LTOT). Conclusions. Severity stratification of COPD patients according to respiratory function classes as outlined in GOLD guidelines and need for LTOT are confirmed as important predictors of hospitalisation for an exacerbation.

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Combination antibiotic therapy versus monotherapy in the treatment of acute exacerbations of chronic obstructive pulmonary disease: an open-label randomized trial

BMC Infectious Diseases ◽

10.1186/s12879-021-06687-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Phuong Nguyen Thi Thu ◽

Minh Ngo Thị Huong ◽

Ngan Tran Thi ◽

Hoi Nguyen Thanh ◽

Khue Pham Minh

Keyword(s):

Clinical Success ◽

Chronic Obstructive ◽

Gram Negative Bacteria ◽

Beta Lactam ◽

Open Label ◽

Obstructive Pulmonary Disease ◽

Gram Negative ◽

Copd Exacerbations ◽

Beta Lactam Antibiotics ◽

Acute Exacerbations

Abstract Background The role of antibiotics in the treatment of chronic obstructive pulmonary disease (COPD) exacerbations and their effectiveness in combination have not been clearly established. To determine whether using a combination of fluoroquinolones and beta-lactams improves the clinical and microbiological efficacy of antibiotics on day 20 of treatment, we conducted an open-label randomized trial based on clinical outcomes, microbiological clearance, spirometry tests, and signs of systemic inflammation in patients hospitalized with acute exacerbations of COPD. Methods We enrolled 139 subjects with COPD exacerbations, defined as acute worsening of respiratory symptoms leading to additional treatment. Patients were divided randomly into two groups: 79 patients using beta-lactam antibiotics alone and 60 using beta-lactam antibiotics plus fluoroquinolones. Clinical and microbiological responses, spirometry tests, symptom scores, and serum C-reactive protein (CRP) levels were evaluated. Results Clinical success, lung function, and symptoms were similar in patients with or without fluoroquinolone administration on days 10 and 20. Combination therapy was superior in terms of microbiological outcomes and reduction in serum CRP value. Although equivalent to monotherapy in terms of clinical success, the combination showed superiority in terms of microbiological success and a decrease in CRP. The combination therapy group had a higher microbiological success rate with gram-negative bacteria than the monotherapy group with Pseudomonas aeruginosa (100% vs. 33.3%, respectively) and Acinetobacter baumanii (100% vs. 20%, respectively) (P < 0.05). Conclusions Concomitant use of fluoroquinolone and beta-lactam antibiotics for bacterial infections during COPD exacerbations caused by gram-negative bacteria appear to be effective and should be applied in clinical practice.

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Neuropsychiatric Adverse Events During 12 Months of Treatment with Efavirenz in a Treatment-Naïve HIV-Infected Population in China: A Prospective Cohort Study

10.21203/rs.3.rs-85006/v1 ◽

2020 ◽

Author(s):

Lili Dai ◽

Sen Wang ◽

Ying Shao ◽

Yali Wang ◽

Jiangzhu Ye ◽

...

Keyword(s):

Cohort Study ◽

Antiretroviral Therapy ◽

Adverse Events ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Sleep Disturbances ◽

Neuropsychiatric Disorders ◽

Factors Associated ◽

Anxiety Depression

Abstract Background: Efavirenz (EFV) is a widely used antiretroviral therapy (ART), but side effect risks of neuropsychiatric adverse events (NPAEs) have not been investigated in Chinese populations receiving rapid ART. Methods: This prospective cohort study assessed HIV-infected patients initiating antiretroviral treatment with EFV to determine prevalence of and factors associated with NPAEs over a 12-month follow-up period using the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index (PSQI). Results: A total of 546 patients were enrolled. Prevalence of anxiety, depression, and sleep disturbances at baseline were 30.4%, 22.7%, and 68.1%, respectively. Six patients discontinued treatment due to drug related NPAEs. Treatment was associated with improvements in HADS-A, HADS-D, and PSQI scores over the 12-month follow-up, and the frequencies of patients with anxiety, depression, and sleep disturbances significantly decreased after 12 months. Abnormal baseline HADS-A, HADS-D, and PSQI scores and other factors, including high school education or lower, unemployment, divorce, and WHO III/IV stages, were associated with severe neuropsychiatric disorders over the 12 months. Conclusions: These findings suggested EFV-based first-line antiretroviral therapy was well-tolerated and associated with improvements in HADS-A, HADS-D, and PSQI scores. Certain risk factors associated with neuropsychiatric disorders may be useful in identifying HIV-infected patients at higher NPAE risk.

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T1. CLINICAL PROFILE AND PREVALENCE OF POSTTRAUMATIC STRESS SYMPTOMS AMONG SERVICE-USERS REFERRED FOR PSYCHOLOGICAL FOLLOW-UP: UTILITY OF ASSESSING SYMPTOMS SEVERITY RANGE

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa029.561 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S231-S231

Author(s):

Danielle Penney ◽

Ghassan El-Baalbaki ◽

Martin Lepage

Keyword(s):

Social Anxiety ◽

Posttraumatic Stress ◽

Posttraumatic Stress Symptoms ◽

Service Users ◽

Dsm 5 ◽

Criterion A ◽

Stress Symptoms ◽

Specialized Services ◽

Anxiety Depression

Abstract Background Individuals with psychosis and comorbid posttraumatic stress disorder (PTSD) typically present with more severe forms of illness. Subthreshold posttraumatic stress symptoms (PTSS) are also likely to cause significant distress. There is a need to enhance screening processes for distressing PTSS to encourage appropriate referral to specialized services. The PTSD checklist for DSM-5 (PCL-5) is a widely used self-report to assess PTSS, though there is concern regarding its validity for use in psychosis. If people scoring in the severe PTSS range on the PCL-5 also present with clinical profiles similar to those typically meeting diagnosis for PTSD, it will justify considering a broader range of PTSS and support the use of the PCL-5 as a brief screener. A severe range will arguably capture a wider array of individuals, including those with subthreshold PTSS who also likely require trauma-focused intervention. Methods One hundred and two individuals with psychosis completed the PCL-5 and a battery of clinical scales as part of an intake evaluation following referral for psychological follow-up at a clinic specializing in psychosocial interventions for psychosis. Prevalence and type of DSM-5 criterion A event were explored in conjunction with PTSS severity and referral-type. Pearson correlations identified clinical variables associated with PCL-5 total scores and were subsequently entered into a multivariate analysis of variance (MANOVA) with dichotomized PTSS severity categories (low, moderate, severe). Post hoc analyses explored significant interactions. Results Of the 102 participants, 21.6% reported no prior trauma and 14.7% reported non-valid events. Sixty-five participants were included in the analysis; 6.2% of which were referred for trauma. 81.5% reported criterion A events, 10.8% reported psychosis-related events, and 7.7% did not disclose an event. PCL-5 scores were dichotomized using the 33rd and 66th percentiles, translating into low (≤ 24), moderate (25–47), and severe (≥48) groups. Delusion severity and subjective stress, anxiety, depression, social anxiety, quality of life (QoL), and wellbeing were entered into a one-way MANOVA with PTSS severity groups. Significant main effects surviving Bonferroni correction emerged for all variables except delusion severity (F(2,40) = 3.06, p = .058) and wellbeing (F(2,56) = 1.50, p =.233). Stress (F(2,62) = 7.37, p = .001) was higher in the severe (M = 13.13, SD = 5.18) versus low group (M = 7.05, SD = 4.40, p = .001). Anxiety (F(2,62) = 8.02, p = .001) was also higher in the severe (M = 12.30, SD = 5.07) compared to low group (M = 5.85, SD = 5.06, p = .000), and depression (F(2,62) = 5.37, p = .007) was additionally higher in the severe (M = 12.61, SD = 5.73) compared to low group (M = 7.20, SD = 4.97, p = .005). Finally, social anxiety (F(2,58) = 4.25, p = .026.) was higher in the severe (M = 7.76, SD = 3.58) versus low group (M = 4.68, SD = 3.68, p = .029), while QoL (F(2,58) = 3.47, p = .038) was lower in the severe (M = 49.95, SD = 10.99) compared to low group (M = 58.95, SD = 13.76, p = .037). Discussion Due to a relatively high number of invalid questionnaires (14.7%), service users should likely complete the PCL-5 in the presence of a health-care practitioner. Findings suggest inadequate referral rates for specialized services when they may indeed benefit the service-user. Severe PTSS was associated with increased symptoms of subjective anxiety, depression, stress, social anxiety, and decreased QoL, regardless of whether diagnostic criteria for PTSD was met. A severe PTSS category likely captures a broader range of individuals requiring specialized intervention and speaks to an important need to both facilitate and increase referral rate for trauma-focused therapy.

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The Interrelated Physiological and Psychological Effects of EcoMeditation

Journal of Evidence-Based Integrative Medicine ◽

10.1177/2515690x18759626 ◽

2018 ◽

Vol 23 ◽

pp. 2515690X1875962 ◽

Cited By ~ 1

Author(s):

Gary Groesbeck ◽

Donna Bach ◽

Peta Stapleton ◽

Katharina Blickheuser ◽

Dawson Church ◽

...

Keyword(s):

Heart Rate ◽

Stress Reduction ◽

Psychological Symptoms ◽

Statistical Significance ◽

Immunoglobulin A ◽

Inadequate Sample Size ◽

Physiological Markers ◽

Anxiety Depression ◽

Salivary Immunoglobulin A

This study investigated changes in psychological and physiological markers during a weekend meditation workshop (N = 34). Psychological symptoms of anxiety, depression, posttraumatic stress disorder (PTSD) and happiness were assessed. Physiological markers included cortisol, salivary immunoglobulin A (SigA), heart rate variability (HRV), blood pressure (BP), and resting heart rate (RHR). On posttest, significant reductions were found in cortisol (−29%, P < .0001), RHR (−5%, P = .0281), and pain (−43%, P = .0022). Happiness increased significantly (+11%, P = .0159) while the increase in SigA was nonsignificant (+27%, P = .6964). Anxiety, depression, and PTSD all declined (−26%, P = .0159; −32%, P = .0197; −18%, P = .1533), though changes in PTSD did not reach statistical significance. No changes were found in BP, HRV, and heart coherence. Participants were assessed for psychological symptoms at 3-month follow-up, but the results were nonsignificant due to inadequate sample size (n = 17). EcoMeditation shows promise as a stress-reduction method.

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COPD: Umgang mit Exazerbationen – Diagnostik, Therapie und Nachsorge

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/a-0723-4172 ◽

2019 ◽

Vol 144 (01) ◽

pp. 21-27

Author(s):

Fabian Leo ◽

Heike Menger

Keyword(s):

Disease Process ◽

Review Article ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Copd Exacerbations ◽

Negative Effect ◽

Diagnostik Therapie ◽

Diagnosis Therapy

AbstractExacerbations are major events in the disease process in patients with chronic obstructive pulmonary disease (COPD). They have a negative effect on the quality of life and the progression of the disease. Frequent exacerbations are associated with increased mortality. In addition to the optimal therapy, the prevention of further exacerbations and the attention to concomitant diseases are prognostically crucial for the patients. In this review article, current recommendations for the diagnosis, therapy and follow-up care of COPD exacerbations are summarized.

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