scholarly journals Long-Term Mortality and Medical Burden of Patients with Chronic Obstructive Pulmonary Disease with and without Subsequent Stroke Episodes

2020 ◽  
Vol 17 (7) ◽  
pp. 2550
Author(s):  
Yu-Shu Yen ◽  
Dorji Harnod ◽  
Cheng-Li Lin ◽  
Tomor Harnod ◽  
Chia-Hung Kao
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Mortality Risk ◽  
Fold Increase ◽  
International Classification Of Diseases ◽  
Chronic Obstructive ◽  
Research Database ◽  
Obstructive Pulmonary Disease ◽  
Medical Visits ◽  
Medical Burden

Background: We used the Taiwan National Health Insurance Research Database (NHIRD) to determine the differences in mortality and medical burden between patients with chronic obstructive pulmonary disease (COPD) with and without stroke. Methods: We enrolled participants aged ≥20 years and defined four subgroups in this study, namely patients with COPD (International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM): 491, 492, 494, and 496), patients with COPD with stroke (ICD-9 CM: 430–438), with COPD without stroke, and comparison subgroups. We calculated the hazard ratios and 95% CIs for all-cause mortality risk, average duration of hospitalization, and frequency of medical visits in these subgroups after adjustments were made for age, sex, and comorbidities. All participants were followed until the date of death, the date they were censored, the date they withdrew from the NHIRD, or 31 December, 2013. Results: In total, 9.70% (men vs. women, 11.19% vs. 8.28%) of patients with COPD developed subsequent stroke during the 14 year follow-up. After a stroke, the risk of mortality exhibited a 2.66- to 5.05-fold increase, especially in the younger ones. COPD with stroke was also a leading factor in the increase in the average number of hospitalization days and frequency of medical visits. Conclusion: The mortality risk of patients with COPD is considerably increased by stroke independent of the other effects of COPD. Moreover, the average number of hospitalization days and frequency of medical visits dramatically increased in patients with COPD after stroke.

scholarly journals Analyzing Mortality Risk and Medical Burden among Patients with Traumatic Brain Injury and Subsequent Dementia

2019 ◽  
Vol 8 (5) ◽  
pp. 686
Author(s):  
Dorji Harnod ◽  
Tomor Harnod ◽  
Cheng-Li Lin ◽  
Chia-Hung Kao
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mortality Risk ◽  
International Classification Of Diseases ◽  
Research Database ◽  
Medical Visits ◽  
Classification Of Diseases ◽  
The Government ◽  
Medical Burden ◽  
Hospital Days

We used the National Health Insurance Research Database of Taiwan to determine whether patients with posttraumatic dementia (PTD) exhibit increased mortality and medical burden than those without it. Patients ≥20 years of age having head injury admission (per the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 850–854, 959.01) between 2000 and 2012 were enrolled as traumatic brain injury (TBI) cohort. A PTD cohort (with ICD-9-CM codes 290, 294.1, 331.0) and a posttraumatic nondementia (PTN) cohort were established and compared in terms of age, sex, and comorbidities. We calculated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of all-cause mortality risk, number of hospital days, and frequency of medical visits in these cohorts. Patients with PTD had a higher mortality rate than did patients with TBI alone (rate per 1000 person-years: 12.00 vs. 6.32), with an aHR of 1.54 (95% CI: 1.32–1.80). Patients with PTD who were aged ≥65 years (aHR = 1.54, 95% CI: 1.31–1.80) or male (aHR = 1.78, 95% CI: 1.45–2.18) exhibited greatly increased risks of mortality. Furthermore, patients with PTD had 19.9 more hospital days and required medical visits 4.49 times more frequently compared with the PTN cohort. Taiwanese patients with PTD had increased mortality risk and medical burden compared with patients who had TBI only. Our findings provide crucial information for clinicians and the government to improve TBI and PTD outcomes.

scholarly journals Drug Metabolism in Severe Chronic Obstructive Pulmonary Disease: A Phenotyping ‘Cocktail’ Study

2020 ◽  
Author(s):  
Richard McNeill ◽  
Mei Zhang ◽  
Michael Epton ◽  
Matthew Doogue
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Drug Metabolism ◽  
Pulmonary Disease ◽  
Fold Increase ◽  
Drug Clearance ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Clinically Significant ◽  
Healthy Participants ◽  
Severe Copd

Aims To evaluate the effect of severe chronic obstructive pulmonary disease (COPD) on drug metabolism by comparing the pharmacokinetics of patients with severe COPD with healthy volunteers and using the modified ‘Inje’ drug cocktail. Methods This was a single-centre pharmacokinetic study with 12 healthy participants and 7 participants with GOLD D COPD. Midazolam 1 mg, dextromethorphan 30 mg, losartan 25 mg, omeprazole 20 mg, caffeine 130 mg, and paracetamol 1000 mg were simultaneously administered and intensive pharmacokinetic sampling was conducted over 8 hours. Drug metabolism by CYP3A4, CYP2D6, CYP2C9, CYP2C19, CYP1A2, UGT1A6 and UGT1A9 in participants with COPD were compared with phenotypes in healthy controls. Results The oral clearance (95% CI) in participants with COPD relative to controls was: midazolam 63% (60-67%), dextromethorphan 72% (40-103%), losartan 53% (52-55%), omeprazole 35% (31-39%), caffeine 52% (50-53%), and paracetamol 73% (72-74%). There was a five-fold increase in AUC for omeprazole and approximately two-fold increases for caffeine, losartan, dextromethorphan, and midazolam. The AUC of paracetamol, which is mostly glucuronidated, was increased by about 60%. Conclusion Severe COPD is associated with a clinically significant reduction in drug clearance. This may be greater for cytochrome P450 substrates than for glucuronidated drugs. This supports reduced starting doses when prescribing for patients with severe COPD.

scholarly journals Sarcopenia, systemic immune-inflammation index and all-cause mortality in middle-aged and older people with chronic obstructive pulmonary disease and asthma: a population-based study

2021 ◽  
pp. 00628-2021
Author(s):  
Elizabeth Benz ◽  
Sara R.A. Wijnant ◽  
Katerina Trajanoska ◽  
Johnmary T. Arinze ◽  
Emmely W. de Roos ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Older People ◽  
Pulmonary Disease ◽  
Mortality Risk ◽  
Study Groups ◽  
Population Based ◽  
Chronic Obstructive ◽  
Middle Aged ◽  
Obstructive Pulmonary Disease ◽  
All Cause Mortality

BackgroundIncreasing evidence suggests that sarcopenia and a higher systemic immune-inflammation index (SII) are linked with morbidity in patients with chronic obstructive pulmonary disease (COPD). However, whether these two conditions contribute to all-cause mortality in middle-aged and older patients with COPD or asthma is unclear. Therefore, we investigated the association between sarcopenia, SII, COPD, or asthma and all-cause mortality in a large-scale population-based setting.MethodsBetween 2009 and 2014, 4482 participants (aged>55 years, 57.3% female) from the population-based Rotterdam Study were included. COPD and asthma patients were clinically and spirometry-based diagnosed. Six study groups were defined according to the presence or absence of COPD or asthma and sarcopenia. Cox regression models were used to assess all-cause mortality in the study groups, adjusted for sex, age, BMI, SII, smoking, oral corticosteroid use and comorbidities. In addition, all participants were categorised into sex-specific quartiles of SII and mortality in these groups was compared.ResultsOver a median follow-up of 6.1 years (IQR 5.0–7.2), 466 (10.4%) persons died. Independent of the presence of sarcopenia, participants with COPD had a higher risk of all-cause mortality (HR: 2.13 [95% CI: 1.46 to 3.12], and HR: 1.70 [95% CI: 1.32 to 2.18]). Compared to lower SII levels, higher SII levels increased mortality risk even in people without sarcopenia, COPD or asthma.ConclusionMiddle-aged and older people with COPD, higher SII levels or sarcopenia had an independently increased mortality risk. Our study suggests prognostic usefulness of routinely evaluating sarcopenia and SII in older people with COPD or asthma.

scholarly journals Enhanced risk of traumatic brain injury in patients with chronic obstructive pulmonary disease

2019 ◽  
Vol 68 (4) ◽  
pp. 846-855
Author(s):  
Tang-Hsiu Huang ◽  
Chiung-Zuei Chen ◽  
Hung-I Kuo ◽  
Hong-Ping Er ◽  
Sheng-Hsiang Lin
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Chronic Obstructive ◽  
Research Database ◽  
Obstructive Pulmonary Disease ◽  
Risk Of Death ◽  
Increased Risk

This study tests our hypothesis that patients with chronic obstructive pulmonary disease (COPD) have an increased risk of traumatic brain injury (TBI).In this nationwide retrospective cohort study, we used a subset of Taiwan’s National Health Insurance Research Database, involving 1 million randomly selected beneficiaries. Patients with newly diagnosed COPD between 2000 and 2008 were identified. They were subgrouped as ‘COPDAE+’ (if they had severe acute exacerbation of COPD during the follow-ups) or ‘COPDAE−’ (if they had no acute exacerbation), and were frequency matched with randomly selected subjects without COPD (the ‘non-COPD’ group). Baseline differences were balanced by the inverse probability of treatment weighting based on the propensity score. For each patient, the risk of TBI during the subsequent 5 years was determined. The competing risk of death was controlled.We identified 3734 patients in ‘COPDAE+’, and frequency matched them with 11,202 patients in ‘COPDAE−’ and 11,202 subjects in ‘non-COPD’. Compared with those in ‘non-COPD’, patients in ‘COPDAE+’ and ‘COPDAE−’ had an increased risk of TBI: the adjusted HR for ‘COPDAE+’ was 1.50, 95% CI 1.31 to 1.73, and that for ‘COPDAE−’ was 1.21, 95% CI 1.09 to 1.34. The highest risk was observed in the ‘COPDAE+’ group that aged <65 (the adjusted HR was 1.92; 95% CI 1.39 to 2.64).COPD has been linked to complications beyond the respiratory system. In this study we showed that COPD is associated with an increased risk of TBI.

scholarly journals Real-world effectiveness evaluation of budesonide/formoterol Spiromax for the management of asthma and chronic obstructive pulmonary disease in the UK

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022051
Author(s):  
Jaco Voorham ◽  
Nicolas Roche ◽  
Hicham Benhaddi ◽  
Marianka van der Tol ◽  
Victoria Carter ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Disease Control ◽  
Pulmonary Disease ◽  
Real World ◽  
Fixed Dose ◽  
Chronic Obstructive ◽  
Research Database ◽  
End Points ◽  
Obstructive Pulmonary Disease ◽  
The Uk

ObjectivesBudesonide/formoterol (BF) Spiromax®is an inhaled corticosteroid/long-acting β2-agonist fixed-dose combination (FDC) inhaler, designed to minimise common inhaler errors and provide reliable and consistent dose delivery in asthma and chronic obstructive pulmonary disease (COPD). We evaluated non-inferiority of BF Spiromax after changing from another FDC inhaler, compared with continuing the original inhaler.MethodsPatients with asthma and/or COPD who switched to BF Spiromax were matched (1:3) with non-switchers. Data were obtained from the Optimum Patient Care Research Database and Clinical Practice Research Datalink in the UK. The primary end point was the proportion of patients achieving disease control (using the risk domain control (RDC) algorithm); secondary end points were: exacerbation rate, short-acting β2-agonist (SABA) use and treatment stability (achieved RDC; no maintenance treatment change). Non-inferiority was defined as having 95% CI lower bound above −10%, using conditional logistic regression and adjusted for relevant confounders.ResultsComparing 385 matched patients (asthma 253; COPD 132) who switched to BF Spiromax with 1091 (asthma 743; COPD 348) non-switchers, non-inferiority of BF Spiromax in RDC was demonstrated (adjusted difference: +6.6%; 95% CI –0.3 to 13.5). Among patients with asthma, switchers to BF Spiromax versus BF Turbuhaler®reported fewer exacerbations (adjusted rate ratio (RR) 0.76;95% CI 0.60 to 0.99; p=0.044); were less likely to use high daily doses of SABA (adjusted OR 0.71;95% CI 0.52 to 0.98; p=0.034); used fewer SABA inhalers (adjusted RR 0.92;95% CI 0.86 to 0.99; p=0.019); and were more likely to achieve treatment stability (adjusted OR 1.44;95% CI 1.02 to 2.04; p=0.037). No significant differences in these end points were seen among patients with COPD.ConclusionsAmong UK patients with asthma and COPD, real-world use of BF Spiromax was non-inferior to BF Turbuhaler in terms of disease control. Among patients with asthma, switching to BF Spiromax was associated with reduced exacerbations, reduced SABA use and improved treatment stability versus continuing on BF Turbuhaler.

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