EVALUATION OF EFFECT OF INHALED CORTICOSTEROID (ICS) ON SPIROMETRIC PARAMETERS OF COPD PATIENTS

2021 ◽  
Vol 3 (4) ◽  
pp. 14-19
Author(s):  
MD. Amal Maghferatullah ◽  
MD. Sultan Muhammad Khawaja
Keyword(s):  
Cause Of Death ◽  
Positive Impact ◽  
Age Groups ◽  
Observational Research ◽  
Chronic Obstructive ◽  
Inhaled Corticosteroid ◽  
Study Research ◽  
Group I ◽  
Copd Patients ◽  
The World

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is currently the fourth leading cause of death in the world but is projected to be the 3rd leading cause of death by 2020. More than 3 million people died of COPD in 2012 accounting for 6% of all deaths globally. COPD represent an important public health challenge that is both preventable and treatable. COPD is a major cause of chronic morbidity and mortality throughout the world; many people suffer from this disease for years, and die prematurely from it or its complications. Afghanistan is also one of those countries in which the mortality rate of COPD has gradually increased, therefore this problem needs prompt attention and is more essential to focus on. Objective: This study aimed to determine and evaluate the effect of inhaled corticosteroid (ICS) on Spirometric parameters of COPD patients and association between inhaled corticosteroid (ICS) and changes of spirometric parameters of various age groups, gender and smokers in OPD patients of COPD of Khost province of Afghanistan. Material and Methods: It is prospective observational research, on 100 COPD patients in Khost province from 2019/3/22 to 2019/8/24. Spirometric parameters of all 100 patients under study (research) after diagnosis of COPD before treatment such as FVC, FEV1 and PEFR by (ME1 2AZ) model spirometer manufactured by (VYair) Company in (2005), diagnosed and recorded in computer special format, then inhaled corticosteroids therapy prescribed for three months and prescriptions are copied. After three months of treatment, the spirometric parameters of all 100 patients under study (research) were re-diagnosed and recorded using this model spirometer. The pre-treatment and post-treatment recorded spirometric parameters processing, comparison and evaluation results have been identified by IBM SPSS-25 version. Results: The study was conducted over a five month period from March 2019 to August 2019 in 100 COPD patients in Khost province. Initially the effects of ICS on spirometric parameters were evaluated in all COPD patients and it was proved that ICS has a positive impact on all three spirometric parameters of all age groups, The average FEV1 before ICS is 67.13 ∓3,79 and after ICS is 74.69 ∓3,70 the positive improvement between the average is 7.56%. Average FVC before ICS is 74.37 ∓4,33 and after ICS is 81.71 ∓ 4,41, improvement between average is 7.34%. Average PEFR before ICS is 67.15 ∓ 7,46 and after ICS 83.53 ∓ 7,39, improvement between average is 16.38%.The progression between the average is seen in all parameters, but the effect on PEFR (16.38%) is more pronounced than in FEV1 and FVC and in all three parameters P less then 0.05(see table-1). The effects of ICS on all three spirometric parameters in different age groups of total COPD patients showed that ICS affects all age groups, but the age group VI (70-79Y) has an average of 67.43 FEV1 before ICS and 75.86 after ICS, with a positive improvement between the average of 8.43%.The FVC average before ICS is 74.63 and after ICS is 83.23, the improvement between the average is 8.60%. The average PEFR before ICS is 64.96 and after ICS is 82.60, the improvement between the average is 17.63%. The effect of ICS is most pronounced on all three spirometric parameters of this age category. The second row has a significant effect on the group VII (80-90Y) and the third row has a significant effect on the group V (60-69Y). The effect of ICS gradually decreases from the first group I (22-29Y), this meaning that ICS is more effective in older age groups than in younger age groups (see table-2). Research on gender, tobacco use, and middle age in all COPD patients showed that the Khost province's COPD prevalence was 23 (23%) in males and 77 (77%) in females. COPD is more prevalent in female (77%) than in male. Also, smoking does not significantly affect the prevalence of COPD, as the total percentage of smokers is 9 (9%) and the average age of patients with COPD is 61.05 years (see Table 3). Conclusion: Overall, the findings indicated that ICS has a positive impact on spirometric parameters of all age groups of COPD patients, but ICS has significant effect on PEFR parameter. ICS also has a positive impact on spirometric parameters of all age groups of COPD patients, but ICS have a significant effect on spirometric parameters of VI-(70-79Y) and V-(60-69Y) age groups and ICS effect in young age groups gradually decreased. Moreover prevalence of COPD at Khost province is significantly increased in female. Smoking has not significant effect on prevalence of COPD. Mean age if COPD patients elderly at Khost province.

scholarly journals The Prevalence of Diabetes Mellitus in Chronic Obstructive Pulmonary Disease Patients

2020 ◽  
Vol 40 (1) ◽  
pp. 48-57
Author(s):  
Mariska Pangaribuan ◽  
Faisal Yunus ◽  
Triya Damayanti ◽  
Rochsismandoko Rochsismandoko
Keyword(s):  
Diabetes Mellitus ◽  
Cross Sectional Study ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Inhaled Corticosteroid ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Number Of Patients

Backgrounds: Type 2 diabetes mellitus (DM) is a common comorbidity of COPD. COPD may be considered as a risk factor for new onset type 2 DM via multiple pathophysiological alterations such as systemic inflammation, smoking, oxidative stress, obesity and inhaled corticosteroid use. Exact prevalence of DM in COPD patients in Indonesia still unclear. Co-morbid conditions like DM have great impact on the outcome of COPD in the form of severity, morbidity and mortality. Methods: A cross sectional study was done in Asthma-COPD clinic Persahabatan Hospital from February to March 2017 to screen COPD patients for DM. Sixty-four subjects were recruited. Interview, physical examination and laboratory testing were performed in all subjects. Results: A total of 64 patients with COPD (Males=60, Female=4) with mean age 65±8.7 were screened for DM. Patients with known history of DM were 12 subjects (18.8%) and were enrolled as known DM cases. Remaining 52 subjects (81.3%) whose DM status was unclear were screened by random or fasting blood sugar and HbA1c. Two subjects (3.1%) were considered as newly diagnosed DM cases. Prevalence of DM in present study was 21.9%. Number of patients with pre-diabetes was 16 subjects (25%). There was no significant relationship between gender, age, smoking, nutritional status, airflow limitation and inhaled corticosteroid use in occurrence of DM among COPD patients. Conclusions: Prevalence of DM in COPD patients in the present study is 21.9%. It is important to screen all COPD patients for DM routinely. (J Respir Indo. 2020; 40(1): 48-57)

scholarly journals Chronic obstructive pulmonary disease patients electronic register analysis: the effectiveness of patient’s dynamic follow up and evaluation of treatment program

2019 ◽  
Vol 91 (1) ◽  
pp. 78-83
Author(s):  
V Ju Mishlanov ◽  
I V Shubin ◽  
K N Bekker ◽  
A V Katkova ◽  
E P Koshurnikova
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Pneumococcal Infection ◽  
Chronic Obstructive ◽  
Inhaled Corticosteroid ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Register Analysis ◽  
Long Acting

In the last few years new informatics methods were implemented in medicine and allowed to create big data including individual clinical markers of every patient. It is suggested that clinical electronic patient’s register analysis will present accurate information about different treatment programs effectiveness, including those whose effectiveness is not still proved today. The aim of the study. To estimate the effectiveness of clinical patients register implementation as well as to analyze different treatment and prophylactic programs on chronic obstructive pulmonary disease (COPD) patients’ structure. Materials and methods. The COPD patient’s register consists of 4257 cases. Spirometrical data were evaluated. Dynamic follow was performed on 567 COPD patients. Bronchodilator’s therapy was estimated as well as combined inhaled corticosteroid/ long acting β2-agonist medications and vaccination against pneumococcal infection. Results. Computer program “Electronic polyclinic” proposed by the authors of this article is effective in precision of diagnostic decision making in cohort study, dynamic follow up after clinical symptoms, evaluation of instrumental and laboratory results, prophylactics and treatment effectiveness, “clinical patients registers” automatic formation using syndrome or nosological principle, checking the COPD patients in the group of those with bronchial obstruction. Conclusion. Positive effects of long-acting bronchodilator treatment on COPD exacerbation decreasing and more expressed effect of inhaled corticosteroid/ long acting β2-agonists were confirmed. More interesting result was influence of vaccination against pneumococcal infection PCV13 (polyvalent conjugated vaccine) on exacerbation frequency and dyspnea severity.

scholarly journals Should I stay or should I go? COPD and air travel

2018 ◽  
Vol 27 (148) ◽  
pp. 180030 ◽  
Author(s):  
Begum Ergan ◽  
Metin Akgun ◽  
Angela Maria Grazia Pacilli ◽  
Stefano Nava
Keyword(s):  
Severe Disease ◽  
Air Travel ◽  
Current Evidence ◽  
Chronic Obstructive ◽  
Active Lifestyle ◽  
Time Saving ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
The World ◽  
Potential Risks

Chronic obstructive pulmonary disease (COPD) is a challenging respiratory problem throughout the world. Although survival is prolonged with new therapies and better management, the magnitude of the burden resulting from moderate-to-severe disease is increasing. One of the major aims of the disease management is to try to break the vicious cycle of patients being homebound and to promote an active lifestyle. A fundamental component of active daily life is, of course, travelling. Today, the world is getting smaller with the option of travelling by air. Air travel is usually the most preferred choice as it is easy, time saving, and relatively inexpensive. Although it is a safe choice for many passengers, the environment inside the aeroplane may sometimes have adverse effects on health. Hypobaric hypoxaemia due to cabin altitude may cause health risks in COPD patients who have limited cardiopulmonary reserve. Addressing the potential risks of air travel, promoting proactive strategies including pre-flight assessment, and education of COPD patients about the “fitness to fly” concept are essential. Thus, in this narrative review, we evaluated the current evidence for potential risks of air travel in COPD and tried to give a perspective for how to plan safe air travel for COPD patients.

Risk of Cardiovascular and Cerebrovascular Events in COPD Patients Treated With Long-Acting β2-Agonist Combined With a Long-Acting Muscarinic or Inhaled Corticosteroid

2017 ◽  
Vol 51 (11) ◽  
pp. 945-953 ◽  
Author(s):  
Jennifer C. Samp ◽  
Min J. Joo ◽  
Glen T. Schumock ◽  
Gregory S. Calip ◽  
A. Simon Pickard ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Fixed Dose ◽  
Chronic Obstructive ◽  
Inhaled Corticosteroid ◽  
Coronary Syndrome ◽  
Copd Patients ◽  
Cerebrovascular Events ◽  
Significant Difference ◽  
Long Acting

Background: The recent approval of several fixed-dose combination long-acting β2-agonist (LABA) and long-acting muscarinic antagonist (LAMA) products has increased the use of dual bronchodilators in the treatment of chronic obstructive pulmonary disease (COPD). Understanding the comparative safety of this combination is important for informing treatment decisions. Objective: To compare the risk of cardiovascular and cerebrovascular (CCV) events associated with LABA/LAMA compared with a combination of LABA and inhaled corticosteroid (ICS). Methods: This was a retrospective, observational cohort study using health insurance claims data to identify COPD patients initiating LABA/LAMA or LABA/ICS. CCV outcomes included hospitalizations with a primary diagnosis for acute coronary syndrome, heart failure, cardiac dysrhythmia, stroke, or transient ischemic attack. Patients were followed until they experienced an event, discontinued treatment, initiated medication from the opposite cohort, or lost enrollment. Patients were matched 1:4 on propensity scores, and time to event was compared using Cox proportional hazards models. Results: After matching, there were 3842 patients in the LABA/LAMA cohort and 15 225 in the LABA/ICS cohort. Cardiovascular events in the LABA/LAMA cohort were lower than in the LABA/ICS: hazard ratio (HR) = 0.794; 95% CI = 0.623-0.997. No significant difference in the risk of cerebrovascular events (HR = 1.166; 95% CI = 0.653-1.959) was observed. Conclusions: Despite concerns about the CCV effects of LAMA and LABA monotherapy, the LABA/LAMA combination had similar or lower risk of these events in comparison to LABA/ICS. Further studies are recommended to confirm these findings.

scholarly journals Heart failure quantified by underlying cause and multiple cause of death in Brazil between 2006 and 2016

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Paolo Blanco Villela ◽  
Sonia Carvalho Santos ◽  
Glaucia Maria Moraes de Oliveira
Keyword(s):  
Heart Failure ◽  
Cause Of Death ◽  
Health Management ◽  
Age Groups ◽  
International Classification Of Diseases ◽  
Geographic Region ◽  
Chronic Obstructive ◽  
Mortality Trends ◽  
Historical Series ◽  
Underlying Cause Of Death

Abstract Background The Global Burden of Disease (GBD) does not produce estimates of heart failure (HF) since this condition is considered the common end to several diseases (i.e., garbage code). This study aims to analyze the interactions between underlying and multiple causes of death related to HF in Brazil and its geographic regions, by sex, from 2006 to 2016. Methods Descriptive study of a historical series of death certificates (DCs) related to deaths that occurred in Brazil between 2006 and 2016, including both sexes and all age groups. To identify HF as the underlying cause of death or as a multiple cause of death, we considered the International Classification of Diseases (ICD) code I50 followed by any digit. We evaluated the deaths and constructed graphs by geographic region to compare with national data. Results We included 1,074,038 DCs issued between 2006 and 2016 that included code I50 in Parts I or II of the certificate. The frequency of HF as the multiple cause of death in both sexes was nearly three times higher than the frequency of HF as an underlying cause of death; this observation remained consistent over the years. The Southeast region had the highest number of deaths in all years (about 40,000 records) and approximately double the number in the Northeast region and more than four times the number in the North region. Codes of diseases clinically unrelated to HF, such as diabetes mellitus, chronic obstructive pulmonary disease, and stroke, were mentioned in 3.11, 2.62, and 1.49% of the DCs, respectively. Conclusions When we consider HF as the underlying cause of death, we observed an important underestimation of its impact on mortality, since when analyzed as a multiple cause of death, HF is present in almost three times more deaths recorded in Brazil from 2006 to 2016. The mentioning of conditions with little association with HF at the time of the death highlights the importance of HF as a complex syndrome with multiple components that must be considered in the analysis of mortality trends for implementation of public health management programs.

scholarly journals Short-term responses to high-dose inhaled corticosteroid treatment in patients with chronic obstructive pulmonary disease with a fractional nitric oxide concentration over 35 parts per billion: A single-centre pre–post study

2020 ◽  
Vol 4 (1) ◽  
pp. 012-017
Author(s):  
Shiroshita Akihiro ◽  
Tanaka Yu ◽  
Nakashima Kei ◽  
Shiraishi Atsushi ◽  
Matsui Hiroki ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Inhaled Corticosteroids ◽  
Corticosteroid Treatment ◽  
Exhaled Nitric Oxide ◽  
Chronic Obstructive ◽  
Inhaled Corticosteroid ◽  
Fractional Exhaled Nitric Oxide ◽  
Copd Patients ◽  
Oxide Concentration ◽  
Nitric Oxide Concentration

Introduction: There is currently no strategy for identifying chronic obstructive pulmonary disease (COPD) patients whose pulmonary function could benefit from inhaled corticosteroids. We investigated whether a 28-day regime of inhaled corticosteroids improved pulmonary function test results among COPD patients with a fractional exhaled nitric oxide concentration > 35 parts per billion. Methods: This single-centre one-arm pre–post trial included COPD patients with a fractional exhaled nitric oxide concentration > 35 parts per billion treated at our institution from September 2018 to August 2019. Patients were administered budesonide (200 μg, 8 puffs daily) for 28 days. The primary outcome measure was the difference between the forced expiratory volume in 1 s (FEV1) at baseline and after 28 days of inhaled corticosteroid treatment. Secondary outcomes included differences in COPD Assessment Test scores, %FEV1, and that between the percent forced vital capacity (%FVC) at baseline and after 28 days of treatment. Results: Twenty patients completed the 28-day inhaled corticosteroid regime. The mean difference in FEV1 between day 1 and day 28 was 340 mL (95% confidence interval: −100 to 770 mL; p = 0.122). The mean differences in secondary outcomes were: %FVC, −0.16% (95% confidence interval [CI]: −2.84 to 2.53%; p = 0.905); %FEV1, 1.63% (95%CI: −4.56 to 7.81%; p = 0.589); COPD Assessment Test score, −2.50 (95%CI: −5.72 to 0.72; p = 0.121). Conclusion: The 28-day course of inhaled corticosteroids yielded no significant difference in FEV1 for COPD patients with a fractional exhaled nitric oxide concentration > 35 parts per billion. Trial registration: University Hospital Medical Information Network Center, UMIN000034005. Registered 3 September 2018, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000038557

Narrative Literature Review Guided Approach of Inhaled Corticosteroid de-escalation in Chronic Obstructive Pulmonary Disease

2021 ◽  
pp. 089719002110537
Author(s):  
Anamarie Tomaich ◽  
Shawnee Klatt ◽  
Michael W. Nagy
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Inhaled Corticosteroid ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Long Acting

Objective To review the 2020 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report recommendations and create an algorithm to assist clinicians in determining which chronic obstructive pulmonary disease (COPD) patients qualify for inhaled corticosteroid (ICS) de-escalation. Data Sources: A literature search of MEDLINE/PubMed from 2002 to August 2021 was conducted using the search terms inhaled corticosteroids, chronic obstructive pulmonary disease, and de-escalation and review of the reference lists of identified articles for pertinent citations. Study Selection and Data Extraction Relevant studies and articles were included if they focused on the utilization of ICS in COPD. Data Synthesis The 2020 GOLD report only recommends triple therapy with ICS, long acting beta agonists, and long acting muscarinic antagonists for patients with frequent exacerbations, frequent hospitalizations, or elevated blood eosinophil counts. Despite this clear framework, patients are prescribed ICS without these characteristics. Available evidence suggests that these patients can be de-escalated from ICS therapy without concern for worsening lung function or exacerbations. Relevance to Patient Care and Clinical Practice: Patients with COPD may be experiencing more risk than benefit on ICS therapy. Clinicians should be knowledgeable on how to evaluate patient therapy for appropriateness and know how to safely deprescribe ICS given their limited efficacy in many COPD patients. Conclusion There remains no specific guidance on how to de-escalate patients off an ICS when the therapy is not indicated. Use of clinical evidence with stepwise algorithms can be models to approach de-escalation of ICS in patients with COPD.

scholarly journals Association between various antioxidants in normals and chronic obstructive pulmonary disease, their alteration and impact of smoking and disease on levels of antioxidants

2019 ◽  
Vol 7 (10) ◽  
pp. 3610
Author(s):  
Kapil Bhatia ◽  
Vivek N. Ambade ◽  
Alka Sontakke ◽  
Dashrath Basannar
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Therapeutic Approaches ◽  
Obstructive Pulmonary Disease ◽  
Group I ◽  
Copd Patients ◽  
Superoxide Dismutase 3 ◽  
Group Ii ◽  
The Impact

Background: There is total alteration of various antioxidants in response to the oxidative stress, which is one of the major patho-physiologic hallmarks in chronic obstructive pulmonary disease (COPD) development. This study aims to establish the correlation between different antioxidants in normals and COPD, study the alteration in the correlation due to COPD and smoking as well as the impact of COPD and smoking on antioxidants levels.Methods: Study comprises of 96 normals as group I and 96 COPD patients as group II. The antioxidants albumin (Alb), bilirubin (Bil), uric acid (UA) ceruloplasmin (Cp), glutathione peroxidase (GSHPx), catalase (CAT) and superoxide dismutase 3 (SOD3) were estimated.Results: Significant lower serum Alb, UA, SOD3 and increased serum Cp and GSHPx were found in Group II. Significant correlation was found between Alb and UA (r=0.24); Bil and UA (r=0.26); Alb and CAT (r=0.211) and SOD3 and CAT (r=0.318) in normals. However, these correlations were altered in COPD where Alb correlates with Bil (r=0.235); UA with CAT (r=0.203) and SOD3 with GSHPx (r=-0.27). The correlation between SOD3 and CAT remained unaltered. Similar correlation of UA with Alb and Bil was observed in nonsmoker normals and between SOD3 and CAT in smoker normals. In COPD, no correlation was seen in nonsmokers, while in smokers Alb correlates with Bil (r=0.316) and SOD3 with CAT (r=0.317).Conclusions: These alterations may have clinical ramifications in further understanding the pathogenesis of COPD and developing therapeutic approaches.

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