scholarly journals Low-dose oral theophylline combined with inhaled corticosteroids for people with chronic obstructive pulmonary disease and high risk of exacerbations: a RCT

2019 ◽  
Vol 23 (37) ◽  
pp. 1-146
Author(s):  
Graham Devereux ◽  
Seonaidh Cotton ◽  
Shona Fielding ◽  
Nicola McMeekin ◽  
Peter J Barnes ◽  
...  
Keyword(s):  
High Risk ◽  
Low Dose ◽  
Hospital Admissions ◽  
Inhaled Corticosteroids ◽  
Drug Regimen ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Dose Oral ◽  
The Mean

Background Despite widespread use of therapies such as inhaled corticosteroids (ICSs), people with chronic obstructive pulmonary disease (COPD) continue to suffer, have reduced life expectancy and utilise considerable NHS resources. Laboratory investigations have demonstrated that at low plasma concentrations (1–5 mg/l) theophylline markedly enhances the anti-inflammatory effects of corticosteroids in COPD. Objective To determine the clinical effectiveness and cost-effectiveness of adding low-dose theophylline to a drug regimen containing ICSs in people with COPD at high risk of exacerbation. Design A multicentre, pragmatic, double-blind, randomised, placebo-controlled clinical trial. Setting The trial was conducted in 121 UK primary and secondary care sites. Participants People with COPD [i.e. who have a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of < 0.7] currently on a drug regimen including ICSs with a history of two or more exacerbations treated with antibiotics and/or oral corticosteroids (OCSs) in the previous year. Interventions Participants were randomised (1 : 1) to receive either low-dose theophylline or placebo for 1 year. The dose of theophylline (200 mg once or twice a day) was determined by ideal body weight and smoking status. Primary outcome The number of participant-reported exacerbations in the 1-year treatment period that were treated with antibiotics and/or OCSs. Results A total of 1578 people were randomised (60% from primary care): 791 to theophylline and 787 to placebo. There were 11 post-randomisation exclusions. Trial medication was prescribed to 1567 participants: 788 in the theophylline arm and 779 in the placebo arm. Participants in the trial arms were well balanced in terms of characteristics. The mean age was 68.4 [standard deviation (SD) 8.4] years, 54% were male, 32% smoked and mean FEV1 was 51.7% (SD 20.0%) predicted. Primary outcome data were available for 98% of participants: 772 in the theophylline arm and 764 in the placebo arm. There were 1489 person-years of follow-up data. The mean number of exacerbations was 2.24 (SD 1.99) for participants allocated to theophylline and 2.23 (SD 1.97) for participants allocated to placebo [adjusted incidence rate ratio (IRR) 0.99, 95% confidence interval (CI) 0.91 to 1.08]. Low-dose theophylline had no significant effects on lung function (i.e. FEV1), incidence of pneumonia, mortality, breathlessness or measures of quality of life or disease impact. Hospital admissions due to COPD exacerbation were less frequent with low-dose theophylline (adjusted IRR 0.72, 95% CI 0.55 to 0.94). However, 39 of the 51 excess hospital admissions in the placebo group were accounted for by 10 participants having three or more exacerbations. There were no differences in the reporting of theophylline side effects between the theophylline and placebo arms. Limitations A higher than expected percentage of participants (26%) ceased trial medication; this was balanced between the theophylline and placebo arms and mitigated by over-recruitment (n = 154 additional participants were recruited) and the high rate of follow-up. The limitation of not using documented exacerbations is addressed by evidence that patient recall is highly reliable and the results of a small within-trial validation study. Conclusion For people with COPD at high risk of exacerbation, the addition of low-dose oral theophylline to a drug regimen that includes ICSs confers no overall clinical or health economic benefit. This result was evident from the intention-to-treat and per-protocol analyses. Future work To promote consideration of the findings of this trial in national and international COPD guidelines. Trial registration Current Controlled Trials ISRCTN27066620. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 37. See the NIHR Journals Library website for further project information.

Patterns of use and trends in the use of medications for the control of COPD in a cohort of Colombian patients, 2017-2019 v1

2021 ◽  
Author(s):  
Jorge Machado Alba
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Population Database ◽  
Obstructive Pulmonary Disease ◽  
Prescription Patterns ◽  
Short Acting ◽  
Patterns Of Use ◽  
Long Acting

Introduction: Chronic obstructive pulmonary disease (COPD) affects approximately 174 million people worldwide.The objective was to determine the trends of the use of medications for COPD in a group of Colombian patients. Methods: This was a retrospective study on prescription patterns of bronchodilators and other medications used in COPD from a population database with follow-up at 12 and 24 months. Patients older than 18 years of age of any sex who had COPD between 2017 and 2019 were included. Sociodemographic variables, medications, treatment schedules for COPD, comorbidities, comedications, and the specialty of the prescriber were considered. Results: A total of 9,476 people with a diagnosis of COPD were evaluated. They had a mean age of 75.9 ± 10.7 years, 50.1% were men, and 86.8% were prescribed by a general practitioner. At the beginning of the follow-up, on average, they received 1.6 medications/patient, mainly short-acting antimuscarinics (3784; 39.9%), followed by short-acting β-agonists (2997, 31.6%) and inhaled corticosteroids (ICS) (2239, 23.6%), but 5083 (53.6%) patients received a long-acting bronchodilator. At the beginning of the follow-up, 645 (6.8%) patients were put on triple therapy with antimuscarinics, β-agonists, and ICS, and at 12 months, this rose to 1388 (20.6%). A total of 57.9% had comorbidities, most often hypertension (44.4%). Conclusions: This group of patients with COPD treated in Colombia frequently received short-acting bronchodilators and ICS, but a growing proportion are undergoing controlled therapy with long-acting bronchodilators, a situation that can improve the indicators of morbidity, exacerbations, and hospitalization.

scholarly journals A study of clinical/biological markers of exacerbation/progression in a cohort of patients admitted with acute excerbation of COPD

2018 ◽  
Vol 5 (1) ◽  
pp. 32
Author(s):  
Shivraj A. L. ◽  
Prakash B.
Keyword(s):  
Hospital Admissions ◽  
Chronic Obstructive ◽  
Clinical Markers ◽  
Significant Drop ◽  
Obstructive Pulmonary Disease ◽  
Protein Levels ◽  
Related Quality ◽  
Frequent Exacerbation ◽  
A Prospective Study

Background:Exacerbations of chronic obstructive pulmonary disease increases the morbidity, hospital admissions, mortality, and strongly influence health-related quality of life. The aims of this study to know the Clinical profile of COPD and acute exacerbation, Role of clinical markers in diagnosis and follow up of exacerbation.Methods: A prospective study of a cohort of 60 patients hospitalized for AECOPD was undertaken to identify markers for frequent exacerbation and progression of disease. Advised to fill the SGRQ questionnaire, At the time of discharge 6MWT done and analyzed. C Reactive protein levels at the time of admission done and analyzed. Sputum grams stain culture, total counts and differential counts done and analyzed. At the time of discharge spirometry done both pre and post bronchodilators by using asthalin inhaler with or without spacer, results were analyzed.Results:There was statistically significant drop in the SPO2 levels in frequent exacerbators over 6 months follow up time. There was statistically significant elevation of sputum Neutrophil counts in frequent exacerbators and Eosinophil counts in infrequent exacerbators, there was a drop in the CRP levels of from the time of initial exacerbation to 6 months follow up time. There was statistically significant drop in FEV1 in frequent exacerbators over 6 months follow up study. The drop of 6MWT was more in patients, who had frequent exacerbations.Conclusions:Patients with more frequent exacerbation have more symptoms, drop in the saturation level and have more sputum neutrophil counts. Patients with more frequent exacerbations will have more deterioration of lung functions (FEV1.6MWT).

Impact of long-term treatment with low-dose inhaled corticosteroids on the bone mineral density of chronic obstructive pulmonary disease patients: Aggravating or beneficial?

Respirology ◽  
2012 ◽  
Vol 18 (1) ◽  
pp. 147-153 ◽  
Author(s):  
ALEXANDROS G. MATHIOUDAKIS ◽  
STAVROULA G. AMANETOPOULOU ◽  
IOANNIS P. GIALMANIDIS ◽  
VICTORIA CHATZIMAVRIDOU-GRIGORIADOU ◽  
GERASIMOS SIASOS ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Chronic Obstructive Pulmonary Disease ◽  
Low Dose ◽  
Inhaled Corticosteroids ◽  
Term Treatment ◽  
Chronic Obstructive ◽  
Mineral Density ◽  
Obstructive Pulmonary Disease ◽  
Long Term Treatment

scholarly journals Differences in the Outcome of Patients with COPD according to Body Mass Index

2020 ◽  
Vol 9 (3) ◽  
pp. 710 ◽  
Author(s):  
Zichen Ji ◽  
Javier de Miguel-Díez ◽  
Christian Reynaldo Castro-Riera ◽  
José María Bellón-Cano ◽  
Virginia Gallo-González ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Hospital Admissions ◽  
Obesity Paradox ◽  
Chronic Obstructive ◽  
P Value ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Critical Unit

Background: In chronic obstructive pulmonary disease (COPD), the “obesity paradox” is a phenomenon without a clear cause. The objective is to analyze the complications of COPD patients according to their body mass index (BMI). Methods: An observational study with a six-year prospective follow-up of 273 COPD patients who attended a spirometry test in 2011. Survival and acute events were analyzed according to the BMI quartiles. Results: A total of 273 patients were included. BMI quartiles were ≤24.23; 24.24–27.69; 27.70–31.25; ≥31.26. During the follow-up, 93 patients died. No differences were found in exacerbations, pneumonia, emergency visits, hospital admissions or income in a critical unit. Survival was lower in the quartile 1 of BMI with respect to each of the 2–4 quartiles (p-value 0.019, 0.013, and 0.004, respectively). Advanced age (hazard ratio, HR 1.06; 95% confidence interval, CI 1.03–1.09), low pulmonary function (HR 0.93; 95% CI 0.86–0.99), exacerbator with chronic bronchitis phenotype (HR 1.76; 95% CI 1.01–3.06), high Charlson (HR 1.32, 95% CI 1.18–1.49), and the quartile 1 of BMI (HR 1.99, 95% CI 1.08–3.69) were identified as risk factors independently associated with mortality. Conclusions: In COPD, low BMI conditions a lower survival, although not for having more acute events.

Atherosclerotic Background of Cirrhosis in Sickle Cell Patients

2021 ◽  
Vol 15 (2) ◽  
Author(s):  
Mehmet Rami Helvaci ◽  
Alper Sevinc ◽  
Celaletdin Camci ◽  
Ali Keskin ◽  
Abdulrazak Abyad ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Inflammatory Process ◽  
Chronic Obstructive ◽  
Leg Ulcers ◽  
Key Words Atherosclerosis ◽  
Obstructive Pulmonary Disease ◽  
Digital Clubbing ◽  
Male Predominance ◽  
The Mean

Background: We tried to understand the presence of any atherosclerotic background of cirrhosis in patients with sickle cell diseases (SCDs). Methods: The study was performed in the Hematology Service of the Mustafa Kemal University on SCDs patients between March 2007 and June 2012. Results: The study included 256 patients with SCDs (127 females). Their mean age was 29.3 years. Cirrhosis was detected in 5.8% (15) of the SCDs patients without any gender difference (6.2% of females versus 5.4% of males, p>0.05). There were 15 (5.8%) patients with chronic obstructive pulmonary disease with a highly significant male predominance (3.1% versus 8.5%, p<0.001). Digital clubbing and pulmonary hypertension were also higher in males, but the differences were nonsignificant in between (4.7% versus 6.2% and 11.0% versus 12.4%, respectively). Similarly, the leg ulcers were significantly higher in males, too (5.5% versus 16.2%, p<0.001). The significant male predominance was also observed in stroke and smoking (3.1% versus 6.2%, p<0.05 and 3.9% versus 11.6%, p<0.001, respectively). There were 14 (5.4%) mortal patients during the five-year follow-up period (6.2% of females and 4.6% of males, p>0.05), and the mean ages were 31.0 and 26.8 years, respectively (p>0.05). Conclusion: Probably cirrhosis is a systemic inflammatory process prominently affecting the hepatic vasculature, and an eventual accelerated atheroscerotic process is the main underlying cause of characteristics of the disease. SCDs are accelerated systemic atherosclerotic processes, too, and the higher prevalence of cirrhosis in SCDs patients may indicate the underlying atherosclerotic background of cirrhosis. Key words: Atherosclerosis, metabolic syndrome, cirrhosis, sickle cell diseases

Using preventive home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive pulmonary disease patients

2012 ◽  
Vol 18 (4) ◽  
pp. 221-225 ◽  
Author(s):  
Birthe Dinesen ◽  
Lisa KE Haesum ◽  
Natascha Soerensen ◽  
Carl Nielsen ◽  
Ove Grann ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Hospital Admission ◽  
Intervention Group ◽  
Home Monitoring ◽  
Control Group ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
The Mean ◽  
Lost To Follow Up

We studied whether preventive home monitoring of patients with chronic obstructive pulmonary disease (COPD) could reduce the frequency of hospital admissions and lower the cost of hospitalization. Patients were recruited from a health centre, general practitioner (GP) or the pulmonary hospital ward. They were randomized to usual care or tele-rehabilitation with a telehealth monitoring device installed in their home for four months. A total of 111 patients were suitable for inclusion and consented to be randomized: 60 patients were allocated to intervention and three were lost to follow-up. In the control group 51 patients were allocated to usual care and three patients were lost to follow-up. In the tele-rehabilitation group, the mean hospital admission rate was 0.49 per patient per 10 months compared to the control group rate of 1.17; this difference was significant ( P = 0.041). The mean cost of admissions was €3461 per patient in the intervention group and €4576 in the control group; this difference was not significant. The Kaplan-Meier estimates for time to hospital admission were longer for the intervention group than the controls, but the difference was not significant. Future work requires large-scale studies of prolonged home monitoring with more extended follow-up.

scholarly journals Chronic obstructive pulmonary disease prevalence and prediction in a high-risk lung cancer screening population

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
John R. Goffin ◽  
Gregory R. Pond ◽  
Serge Puksa ◽  
Alain Tremblay ◽  
Michael Johnston ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Chronic Obstructive Pulmonary Disease ◽  
Cancer Screening ◽  
High Risk ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
High Prevalence ◽  
Screening Population

Abstract Background Chronic obstructive pulmonary disease (COPD) is an underdiagnosed condition sharing risk factors with lung cancer. Lung cancer screening may provide an opportunity to improve COPD diagnosis. Using Pan-Canadian Early Detection of Lung Cancer (PanCan) study data, the present study sought to determine the following: 1) What is the prevalence of COPD in a lung cancer screening population? 2) Can a model based on clinical and screening low-dose CT scan data predict the likelihood of COPD? Methods The single arm PanCan study recruited current or former smokers age 50–75 who had a calculated risk of lung cancer of at least 2% over 6 years. A baseline health questionnaire, spirometry, and low-dose CT scan were performed. CT scans were assessed by a radiologist for extent and distribution of emphysema. With spirometry as the gold standard, logistic regression was used to assess factors associated with COPD. Results Among 2514 recruited subjects, 1136 (45.2%) met spirometry criteria for COPD, including 833 of 1987 (41.9%) of those with no prior diagnosis, 53.8% of whom had moderate or worse disease. In a multivariate model, age, current smoking status, number of pack-years, presence of dyspnea, wheeze, participation in a high-risk occupation, and emphysema extent on LDCT were all statistically associated with COPD, while the overall model had poor discrimination (c-statistic = 0.627 (95% CI of 0.607 to 0.650). The lowest and the highest risk decile in the model predicted COPD risk of 27.4 and 65.3%. Conclusions COPD had a high prevalence in a lung cancer screening population. While a risk model had poor discrimination, all deciles of risk had a high prevalence of COPD, and spirometry could be considered as an additional test in lung cancer screening programs. Trial registration (Clinical Trial Registration: ClinicalTrials.gov, number NCT00751660, registered September 12, 2008)

scholarly journals Inhaled corticosteroids and FEV1 decline in chronic obstructive pulmonary disease: a systematic review

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hannah R. Whittaker ◽  
Debbie Jarvis ◽  
Mohamed R. Sheikh ◽  
Steven J. Kiddle ◽  
Jennifer K. Quint
Keyword(s):  
Inhaled Corticosteroids ◽  
Risk Of Bias ◽  
Long Term Results ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Follow Up Studies ◽  
The Difference ◽  
Rate Of Decline

AbstractRate of FEV1 decline in COPD is heterogeneous and the extent to which inhaled corticosteroids (ICS) influence the rate of decline is unclear. The majority of previous reviews have investigated specific ICS and non-ICS inhalers and have consisted of randomised control trials (RCTs), which have specific inclusion and exclusion criteria and short follow up times. We aimed to investigate the association between change in FEV1 and ICS-containing medications in COPD patients over longer follow up times.MEDLINE and EMBASE were searched and literature comparing change in FEV1 in COPD patients taking ICS-containing medications with patients taking non-ICS-containing medications were identified. Titles, abstract, and full texts were screened and information extracted using the PICO checklist. Risk of bias was assessed using the Cochrane Risk of Bias tool and a descriptive synthesis of the literature was carried out due to high heterogeneity of included studies.Seventeen studies met our inclusion criteria. We found that the difference in change in FEV1 in people using ICS and non-ICS containing medications depended on the study follow-up time. Shorter follow-up studies (1 year or less) were more likely to report an increase in FEV1 from baseline in both patients on ICS and in patients on non-ICS-containing medications, with the majority of these studies showing a greater increase in FEV1 in patients on ICS-containing medications. Longer follow-up studies (greater than 1 year) were more likely to report a decline in FEV1 from baseline in patients on ICS and in patients on non-ICS containing medications but rates of FEV1 decline were similar.Further studies are needed to better understand changes in FEV1 when ICS-containing medications are prescribed and to determine whether ICS-containing medications influence rate of decline in FEV1 in the long term. Results from inclusive trials and observational patient cohorts may provide information more generalisable to a population of COPD patients.

Low-Dose Oral Mini-Pulse Dexamethasone Therapy in Progressive Unstable Vitiligo

2013 ◽  
Vol 17 (4) ◽  
pp. 259-268 ◽  
Author(s):  
Amrinder J. Kanwar ◽  
Rahul Mahajan ◽  
Davinder Parsad
Keyword(s):  
Adverse Effects ◽  
Disease Activity ◽  
Low Dose ◽  
Disease Free Survival ◽  
Pulse Therapy ◽  
Dose Oral ◽  
Dexamethasone Therapy ◽  
Pulse Dexamethasone ◽  
The Mean

Background: The course of vitiligo is unpredictable. If the disease is spreading rapidly, the progression can be controlled with the use of systemic steroids daily or in pulsed form. The present study was planned to assess the efficacy of low-dose dexamethasone oral mini-pulse therapy in progressive unstable vitiligo. Materials and Methods: In this retrospective study, the case records of patients with vitiligo during the period from January 2006 to December 2010 were studied. Patients who had progressive unstable disease were included. These patients were administered oral dexamethasone 2.5 mg per day on 2 consecutive days after breakfast in a week. The patients were asked to come for regular follow-up to assess the arrest of disease activity, relapse of disease activity, and adverse effects. Results: A total of 444 patients were analyzed. In 408 (91.8%) patients, arrest of disease activity was achieved at a mean duration of 13.2 ± 3.1 weeks. In addition, some repigmentation of the lesions was seen in all patients after a mean of 16.1 ± 5.9 weeks. During the follow-up, 50 of 408 (12.25%) patients experienced one or two episodes of relapse in disease activity, which were treated with reinstitution of low-dose dexamethasone oral mini-pulse therapy. The mean disease-free survival (DFS) until the first relapse was 55.7 ± 26.7 weeks, and the mean DFS until the second relapse was 43.8 ± 7.2 weeks. Adverse reactions such as weight gain, lethargy, and acneiform eruptions were observed in 41 (9.2%) patients. Conclusion: Low-dose oral mini-pulse dexamethasone therapy is a good option for arresting progressive unstable vitiligo with minimal adverse effects.

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