scholarly journals Inhalation glucocorticosteroids in the treatment of chronic obstructive pulmonary disease

2020 ◽  
Vol 30 (3) ◽  
pp. 330-343
Author(s):  
S. N. Avdeev ◽  
Z. R. Aisanov ◽  
V. V. Arkhipov ◽  
A. S. Belevskiy ◽  
I. V. Leshchenko ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive Lung Disease ◽  
Clinical Excellence ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Patient Reported ◽  
The Impact

The main objectives of chronic obstructive pulmonary disease (COPD) therapy are to reduce the severity of symptoms and the risk of exacerbations. The article discusses the role of local and systemic inflammation in the pathogenesis of COPD as well as various mechanisms of pharmacological influence on it. Approaches to prescribing basic therapy for patients with COPD, recommended by various national and global guidelines (clinical recommendations of the Russian respiratory society, criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD), guidelines of the National Institute for Health and Clinical Excellence (NICE)), as well as recommendations on the therapy frequency review are considered. Currently, so-called triple combinations – fixed combinations of double bronchodilators with inhaled glucocorticosteroids – are being developed and registered in the world, and their place and significance in the treatment of COPD raise many discussions. The paper discusses the role of fixed triple combinations in reducing the incidence of COPD exacerbations, the impact on functional and patient-reported outcomes, and provides recommendations for the use of triple combinations in patients with COPD, taking into account the benefit/risk ratio.

Non-Invasive Ventilation in Stable Chronic Obstructive Pulmonary Disease

2019 ◽  
Vol 15 (2) ◽  
pp. 120-132 ◽  
Author(s):  
Cosei Valentin-Caius ◽  
Borcea Corina-Ioana ◽  
Zaharie Ana-Maria ◽  
Mihaltan Florin-Dumitru ◽  
Deleanu Oana-Claudia
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Patient Reported ◽  
The Right

The benefit of non-invasive ventilation (NIV) in stable chronic obstructive pulmonary disease (COPD) remains controversial. However, there is increasingly more evidence of NIV efficiency, especially high-flow NIV. This review presents the old and the new evidence of NIV effectiveness in stable COPD, considering pathophysiological arguments for NIV in COPD. Guidelines, randomized controlled trials (RCTs) and crossover studies included in review and metaanalysis based on patient-reported outcomes (PROs) have been analyzed. The role of NIV in rehabilitation and in palliative care and the role of telemedicine in relation with NIV are still up for debate. Challenges in choosing the right device and the optimal mode of ventilation still exist. There are also discussions on the criteria for patient inclusion and on how to meet them. More studies are needed to determine the ideal candidate for chronic NIV and to explain all the benefits of using NIV.

scholarly journals Management of chronic obstructive pulmonary disease: A review focusing on exacerbations

2020 ◽  
Vol 77 (4) ◽  
pp. 259-268
Author(s):  
Suzanne G Bollmeier ◽  
Aaron P Hartmann
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Patient Education ◽  
Disease Management ◽  
Pulmonary Disease ◽  
The United States ◽  
Chronic Obstructive ◽  
Severe Exacerbation ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
The Impact

Abstract Purpose Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality in the United States. Exacerbations— acute worsening of COPD symptoms—can be mild to severe in nature. Increased healthcare resource use is common among patients with frequent exacerbations, and exacerbations are a major cause of the high 30-day hospital readmission rates associated with COPD. Summary This review provides a concise overview of the literature regarding the impact of COPD exacerbations on both the patient and the healthcare system, the recommendations for pharmacologic management of COPD, and the strategies employed to improve patient care and reduce hospitalizations and readmissions. COPD exacerbations significantly impact patients’ health-related quality of life and disease progression; healthcare costs associated with severe exacerbation-related hospitalization range from $7,000 to $39,200. Timely and appropriate maintenance pharmacotherapy, particularly dual bronchodilators for maximizing bronchodilation, can significantly reduce exacerbations in patients with COPD. Additionally, multidisciplinary disease-management programs include pulmonary rehabilitation, follow-up appointments, aftercare, inhaler training, and patient education that can reduce hospitalizations and readmissions for patients with COPD. Conclusion Maximizing bronchodilation by the appropriate use of maintenance therapy, together with multidisciplinary disease-management and patient education programs, offers opportunities to reduce exacerbations, hospitalizations, and readmissions for patients with COPD.

scholarly journals THE ROLE OF MICROBIAL COMMUNITIES OF AIRWAYS IN PATHOGENESIS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

2014 ◽  
Vol 13 (1) ◽  
pp. 153-160 ◽  
Author(s):  
S. V. Fedosenko ◽  
L. M. Ogorodova ◽  
M. A. Karnaushkina ◽  
Ye. S. Kulikov ◽  
I. A. Deyev ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Microbial Communities ◽  
Pulmonary Disease ◽  
Molecular Genetic ◽  
Genetic Identification ◽  
Current Therapy ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
The Impact

This review summarizes the results of studies on the composition of microbial communities in the airways of healthy subjects and in patients with chronic obstructive pulmonary disease. Modern technologies of molecular-genetic identification methods of microorganisms allow to perform a deep analysis  of  the  respiratory  microbiom.  It  is  of  considerable  interest  to  determine  the  role  of  the microbiome in the development of human diseases of the bronchopulmonary system, and to understand the impact of the microbes communities as a course of disease and the important factor for the efficacy of current therapy.

scholarly journals The role of infectious pathogens in exacerbation of chronic obstructive pulmonary disease in Dakahlia Governorate

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Elsayed Ahmed Fahmy ◽  
Heba Wagih Abdelwahab ◽  
Heba Elsayed Eldegla ◽  
Mohammed Khairy Fahmy Elbadrawy
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Negative Impact ◽  
Fungal Growth ◽  
Atypical Mycobacteria ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations

Abstract Background Exacerbations of chronic obstructive pulmonary disease (COPD) represent important events in the management of COPD because of its negative impact on health status and disease progression. The etiology of acute exacerbations of chronic obstructive pulmonary disease (COPDAE) is heterogeneous and still under discussion. So, this study was planned to investigate the role of infectious pathogens (fungi and atypical mycobacteria in addition to the well-known bacteria) in patients with COPD exacerbation in our locality. Results This observational cross-sectional study was conducted on 100 patients with acute exacerbation of COPD. Sputum specimens were collected for mycobacterial and fungal examination in addition to routine sputum bacteriology. All sputum samples were negative for typical and atypical mycobacteria whereas sputum samples of 18 patients (18%) were negative for fungi. Mixed fungal growth was found in 19 patients (19%). Candida was isolated from 67 patients (67%), Aspergillus was isolated from 27 patients (27%), Alternaria was isolated from 3 patients (3%), and other fungi were isolated from 4 patients (4%). As regards sputum bacteriology, sputum samples of 49 patients (49%) have bacterial growth. Streptococcus pneumoniae was isolated from 16 samples (16%) and represents the most frequent bacterial isolate in this study. Conclusion The present study indicates that typical and atypical mycobacteria have no role in COPD exacerbations in our locality. However, fungi and bacteria may have a role in COPD exacerbations.

scholarly journals Inhaled Steroids and Active Smoking Drive Chronic Obstructive Pulmonary Disease Symptoms and Biomarkers to a Greater Degree Than Airflow Limitation

2017 ◽  
Vol 12 ◽  
pp. 117727191773030
Author(s):  
Philip E Silkoff ◽  
Dave Singh ◽  
J Mark FitzGerald ◽  
Andreas Eich ◽  
Andrea Ludwig-Sengpiel ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Air Trapping ◽  
Obstructive Pulmonary Disease ◽  
Current Smoking ◽  
Clinical Biomarkers ◽  
Patient Reported ◽  
The Impact

Rationale: Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease, and development of novel therapeutics requires an understanding of pathophysiologic phenotypes. Objectives: The purpose of the Airways Disease Endotyping for Personalized Therapeutics (ADEPT) study was to correlate clinical features and biomarkers with molecular characteristics in a well-profiled COPD cohort. Methods: A total of 67 COPD subjects (forced expiratory volume in the first second of expiration [FEV1]: 45%-80% predicted) and 63 healthy smoking and nonsmoking controls underwent multiple assessments including patient questionnaires, lung function, and clinical biomarkers including fractional exhaled nitric oxide (FENO), induced sputum, and blood. Measurements and main results: The impact of inhaled corticosteroids (ICSs), and to a lesser extent current smoking, was more associated with symptom control, exacerbation rates, and clinical biomarkers, than severity by FEV1. The ICS-treated smoking subjects were most symptomatic, with significantly elevated scores on patient-reported outcomes and more annual exacerbations ( P < .05). Inhaled corticosteroid users had greater airflow obstruction and air trapping compared with non-ICS users, regardless of smoking status. Smoking, regardless of ICS use, was associated with significantly lower FENO ( P < .05). Smoking, in non-ICS users, was associated with an elevated proportion of sputum neutrophils and reduced sputum macrophages. Increased serum C-reactive protein was observed in smokers but not in ICS and nonsmoking ICS users ( P < .05). In contrast, only air trapping and neutrophilic inflammation increased with severity, defined by postbronchodilator FEV1. Conclusions: Compared with COPD severity by FEV1, ICS use and current smoking were better determinants of clinical characteristics and biomarkers. Use of the ADEPT COPD data promises to prove useful in defining biological phenotypes to facilitate personalized therapeutic approaches.

scholarly journals Eosinophilic inflammation in chronic obstructive pulmonary disease

2019 ◽  
Vol 91 (10) ◽  
pp. 144-152
Author(s):  
S N Avdeev ◽  
N V Trushenko ◽  
Z M Merzhoeva ◽  
M S Ivanova ◽  
E V Kusraeva
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Targeted Therapy ◽  
Pulmonary Disease ◽  
Clinical Manifestations ◽  
Chronic Obstructive ◽  
Eosinophilic Inflammation ◽  
Obstructive Pulmonary Disease ◽  
Pathophysiological Mechanisms ◽  
The Impact

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease that combines various clinical manifestations and pathophysiological mechanisms. It underlies the separation of patients with COPD by phenotypes, endotypes and a personalized therapy of this disease. The implementation of this approach is possible only with the use of appropriate biomarkers. One of the most important biomarkers of COPD is eosinophilia of blood and/or sputum, which is considered as a predictor of frequent exacerbations and the effectiveness of inhaled glucocorticosteroids in patients with COPD. The literature discusses the impact of eosinophilic inflammation on the prognosis, clinical and functional parameters in COPD, and the role of the targeted therapy in the treatment of eosinophilic COPD.

scholarly journals The Use of Triple Therapy in Chronic Obstructive Pulmonary Disease and Outcomes of the IMPACT Trial

2018 ◽  
Vol 4 (1) ◽  
pp. 17 ◽  
Author(s):  
Mario Cazzola ◽  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Triple Therapy ◽  
Pulmonary Disease ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Exacerbation Rate ◽  
Obstructive Pulmonary Disease ◽  
Expert Interview ◽  
Long Acting ◽  
The Impact

Triple inhaled therapy for chronic obstructive pulmonary disease (COPD) comprises the combination of an inhaled corticosteroid (ICS), a long-acting β2-agonist (LABA) and a long-acting muscarinic antagonist (LAMA). The use of triple therapy is recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) for patients who experience recurrent exacerbations despite treatment with either a dual bronchodilator or LABA/ICS combination.1 Evidence exists for the superior efficacy of triple therapy compared with LABA/ICS and LAMA monotherapy with regards to improved lung function, health status, and exacerbation rate. However, the benefits of triple therapy compared with dual bronchodilation (LABA/LAMA) are uncertain.2 The IMPACT study compared triple therapy and dual inhaler therapy comprising LABA/LAMA in patients with COPD.3 In an expert interview, Dr Cazzola discusses this study and its implications for clinical practice.

Treatment of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

1992 ◽  
Vol 5 (4) ◽  
pp. 217-223
Author(s):  
Connie J. Rexing ◽  
Scott D. Troyer ◽  
Diane D. Shackelford ◽  
Wallace E. Geck
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
The United States ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Adrenergic Agents ◽  
Copd Exacerbations ◽  
Sputum Production ◽  
Acute Exacerbations

Chronic obstructive pulmonary disease (COPD) is an ever present problem in the United States. Characterized by features of both bronchitis and emphysema, the course is generally slow and progressive. However, acute exacerbations do occur, averaging one to four exacerbations per patient per year. These exacerbations, typically characterized by increasing dyspnea, cough, and sputum production, often require immediate treatment. As single agents, both anticholinergic and β-adrenergic agents have been proven effective in acute COPD exacerbations, yet their combination may provide little added therapeutic effect over either agent alone. In light of questionable effectiveness and the potential for toxicity, the role of methylxanthines in the management of COPD has been critically evaluated over the past several years. Certain patients may show improvement from the use of corticosteroids and/or antibiotics during an acute exacerbation; however, these patients are not always easily identifiable. Lastly, patients presenting with a PaO2 < 60 mm Hg will usually benefit from oxygen therapy. This article discusses some of the current views on the efficacy of these various treatments for acute COPD exacerbations.

scholarly journals Re-admissions to hospital and patient satisfaction among patients with chronic obstructive pulmonary disease after telemedicine video consultation - a retrospective pilot study

2014 ◽  
Vol 9 ◽  
Author(s):  
Safaa Saleh ◽  
Jan Petter Larsen ◽  
Johannes Bergsåker-Aspøy ◽  
Heidi Grundt
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Patient Satisfaction ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Exacerbations ◽  
Number Of Patients ◽  
Video Consultation ◽  
The Impact

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of acute hospital admissions. The main object of our study was to evaluate the effects of telemedicine video-consultation (TVC) on the frequency of hospital re-admissions due to COPD exacerbations. Our secondary aim was to assess the impact of TVC on the length of re-admission stays within 6 and 12 months follow up after TVC. Patient satisfaction was also evaluated. Methods: The study was a retrospective observational study of COPD patients who after hospital discharge or during outpatient treatment for acute COPD exacerbations, were monitored for 2 weeks by TVC at home by a specialist nurse at the hospital during a pilot project period. Retrospectively, we compared the frequencies (chi-square test) and durations of hospital re-admissions (paired t-test) due to COPD exacerbations within 6 and 12 months follow up after TVC to comparable events 6 and 12 months prior to TVC. Results: Among 99 patients followed for 6 months after TVC, 56 were followed for totally 12 months. The number of patients re-admitted and the number of re-admissions due to COPD exacerbations were not reduced within 6 or 12 months post-TVC, as compared to 6 and 12 months pre-TVC. The mean length of re-admission stays within 12 months post-TVC was markedly reduced as compared to pre-TVC. Patients hospitalised the last 6 and 12 months pre-TVC, had significantly shorter re-admission stays, p = 0.033 and p = 0.001, respectively. Patient satisfaction was high. Conclusion: Despite the failure to demonstrate reduced frequency of re-admissions within 6 and 12 months post-TVC, the re-admission length within 12 months post-TVC was markedly reduced as compared to pre-TVC. The patient satisfaction was high. Future prospective, randomised, controlled trials must be performed before TVC can be recommended in COPD management.

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