scholarly journals Systemic Inflammatory Response and Outcomes in Community-Acquired Pneumonia Patients Categorized According to the Smoking Habit or Presence of Chronic Obstructive Pulmonary Disease

2020 ◽  
Vol 9 (9) ◽  
pp. 2884
Author(s):  
Ernesto Crisafulli ◽  
Catia Cillóniz ◽  
Adamantia Liapikou ◽  
Marcello Ferrari ◽  
Fabiana Busti ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Smoking Habit ◽  
Invasive Mechanical Ventilation ◽  
Community Acquired Pneumonia ◽  
Systemic Inflammatory Response ◽  
Mortality Data ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Icu Admission ◽  
Increased Risk

The systemic inflammatory response (SIR) may help to predict clinical progression, treatment failure, and prognosis in community-acquired pneumonia (CAP). Exposure to tobacco smoke may affect the SIR; the role of smoking in CAP has not been consolidated. We evaluated the SIR and outcomes of hospitalized CAP patients stratified by smoking habits and the presence of COPD. This retrospective analysis was conducted at the Hospital Clinic of Barcelona. Baseline, clinical, microbiological, and laboratory variables were collected at admission, using C-reactive protein (CRP) levels as a marker of SIR. The study outcomes were pleural complications, hospital stay, non-invasive and invasive mechanical ventilation (IMV), and intensive care unit (ICU) admission. We also considered the in-hospital and 30-day mortality. Data were grouped by smoking habit (non-, former-, and current-smokers) and the presence of COPD. Current smokers were younger, had fewer comorbidities, and fewer previous pneumonia episodes. CRP levels were higher in current smokers than in other groups. Current smokers had a higher risk of pleural complications independent of CRP levels, the presence of pleuritic pain, and a higher platelet count. Current smokers more often required IMV and ICU admission. Current smokers have a greater inflammatory response and are at increased risk of pleural complications.

scholarly journals Pneumonic versus Nonpneumonic Exacerbations of Chronic Obstructive Pulmonary Disease

2020 ◽  
Vol 41 (06) ◽  
pp. 817-829
Author(s):  
Ernesto Crisafulli ◽  
Alessandra Manco ◽  
Miquel Ferrer ◽  
Arturo Huerta ◽  
Claudio Micheletto ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Inflammatory Response ◽  
Pulmonary Disease ◽  
Defense Mechanisms ◽  
Community Acquired Pneumonia ◽  
Systemic Inflammatory Response ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Reactive Protein ◽  
The Impact

AbstractPatients with chronic obstructive pulmonary disease (COPD) often suffer acute exacerbations (AECOPD) and community-acquired pneumonia (CAP), named nonpneumonic and pneumonic exacerbations of COPD, respectively. Abnormal host defense mechanisms may play a role in the specificity of the systemic inflammatory response. Given the association of this aspect to some biomarkers at admission (e.g., C-reactive protein), it can be used to help to discriminate AECOPD and CAP, especially in cases with doubtful infiltrates and advanced lung impairment. Fever, sputum purulence, chills, and pleuritic pain are typical clinical features of CAP in a patient with COPD, whereas isolated dyspnea at admission has been reported to predict AECOPD. Although CAP may have a worse outcome in terms of mortality (in hospital and short term), length of hospitalization, and early readmission rates, this has only been confirmed in a few prospective studies. There is a lack of methodologically sound research confirming the impact of severe AECOPD and COPD + CAP. Here, we review studies reporting head-to-head comparisons between AECOPD and CAP + COPD in hospitalized patients. We focus on the epidemiology, risk factors, systemic inflammatory response, clinical and microbiological characteristics, outcomes, and treatment approaches. Finally, we briefly discuss some proposals on how we should orient research in the future.

scholarly journals Influenza in Malaysian adult patients hospitalized with community-acquired pneumonia, acute exacerbation of chronic obstructive pulmonary disease or asthma: a multicenter, active surveillance study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yong Kek Pang ◽  
Ahmad Izuanuddin Ismail ◽  
Yoke Fun Chan ◽  
Adelina Cheong ◽  
Yoong Min Chong ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Active Surveillance ◽  
Community Acquired Pneumonia ◽  
Surveillance Study ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
High Dependency ◽  
Increased Risk

Abstract Background Available data on influenza burden across Southeast Asia are largely limited to pediatric populations, with inconsistent findings. Methods We conducted a multicenter, hospital-based active surveillance study of adults in Malaysia with community-acquired pneumonia (CAP), acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute exacerbation of asthma (AEBA), who had influenza-like illness ≤10 days before hospitalization. We estimated the rate of laboratory-confirmed influenza and associated complications over 13 months (July 2018–August 2019) and described the distribution of causative influenza strains. We evaluated predictors of laboratory-confirmed influenza and severe clinical outcomes using multivariate analysis. Results Of 1106 included patients, 114 (10.3%) were influenza-positive; most were influenza A (85.1%), with A/H1N1pdm09 being the predominant circulating strain during the study following a shift from A/H3N2 from January–February 2019 onwards. In multivariate analyses, an absence of comorbidities (none versus any comorbidity [OR (95%CI), 0.565 (0.329–0.970)], p = 0.038) and of dyspnea (0.544 (0.341–0.868)], p = 0.011) were associated with increased risk of influenza positivity. Overall, 184/1106 (16.6%) patients were admitted to intensive care or high-dependency units (ICU/HDU) (13.2% were influenza positive) and 26/1106 (2.4%) died (2.6% were influenza positive). Males were more likely to have a severe outcome (ICU/HDU admission or death). Conclusions Influenza was a significant contributor to hospitalizations associated with CAP, AECOPD and AEBA. However, it was not associated with ICU/HDU admission in this population. Study registration, NMRR ID: NMRR-17-889-35,174.

scholarly journals Risks associated with tiotropium in chronic obstructive pulmonary disease: overview of the evidence to date

2012 ◽  
Vol 3 (3) ◽  
pp. 123-131 ◽  
Author(s):  
Yoon K. Loke ◽  
Sonal Singh
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Drug Delivery ◽  
Adverse Effects ◽  
Pulmonary Disease ◽  
Urinary Retention ◽  
Mortality Data ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Risk Of Death ◽  
Increased Risk

Tiotropium is a long-acting inhaled anticholinergic agent that is widely used in the treatment of chronic obstructive pulmonary disease (COPD). It was initially launched as the tiotropium HandiHaler formulation, but this was followed by a newer version based on a potentially more efficient drug delivery device, known as Respimat. This Respimat formulation is available worldwide but has not yet succeeded in gaining regulatory approval in the USA. In the past few years, the adverse effects profile of tiotropium has come under close scrutiny owing to concerns about the possibility of urinary and cardiovascular adverse effects. These concerns appeared to have been alleviated following the publication of data from the Understanding Potential Long-Term Impacts on Function with Tiotropium (UPLIFT) trial, which was a large trial of 4 years’ duration. This trial did not show any excess myocardial infarction, renal or urinary adverse events with tiotropium compared with placebo. However, the risk of urinary retention has been in the spotlight again following publication of two observational studies reporting a significantly increased risk of urinary retention in men recently started on inhaled anticholinergics, especially when prostatic hyperplasia coexists. More recently, a meta-analysis of mortality data for the tiotropium Respimat formulation raised the possibility of an increased risk of death, including death from cardiovascular causes. It is unclear if the more efficient drug delivery offered by the Respimat device is hitting a different part of the dose-toxicity curve. In the absence of any evidence of superior clinical efficacy with tiotropium Respimat compared with tiotropium HandiHaler, some experts have argued that there is no compelling reason to choose the Respimat formulation given the new uncertainties about its safety profile.

scholarly journals The Association Between Smoking History and Intensive Phase Treatment Success of Pulmonary Tuberculosis Patients in Dr. Zainoel Abidin Hospital Banda Aceh

2019 ◽  
Vol 38 (4) ◽  
pp. 232-8
Author(s):  
Risa Fitria ◽  
Feni Fitriani Taufik ◽  
Dewi Behtri Yanifitri
Keyword(s):  
Pulmonary Tuberculosis ◽  
Treatment Success ◽  
Smoking Habit ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Important Indicator ◽  
Intensive Phase ◽  
Increased Risk ◽  
Banda Aceh

Background: Many diseases are associated with smoking such as malignant disease, cardiovascular, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), arthritis, impotence, infertility, Alzheimer’s Disease, tuberculosis and others. Smoking is proven to disrupt the ciliary mucosal clearance and it is associated with an increased risk of pulmonary tuberculosis. Sputum conversion is an important indicator to assess the success of TB treatment. This study aims to determine the relation between smoking history and the success intensive phase treatment of pulmonary tuberculosis at Dr Zainoel Abidin Hospital. Method: Prospective cohort study in patients with pulmonary tuberculosis acid-fast bacilli (AFB) positive (+) smokers and non smokers who visited the Integrated Tuberculosis Care (PTT), at outpatient and inpatient pulmonary infection RSU Dr. Zainoel Abidin hospital Banda Aceh from 28 November 2015 until 1 February 2016. Results: A total of 38 subjects were divided into 2 groups (19 subjects with 19 subjects smokers and non-smokers). All subjects smokers are male while nonsmoker subjects consisted of male and female. The results of the first month study (p=0.009), there are 14 non smoker subjects with AFB conversion (73,7%) and 5 subjetcs without AFB conversion. Among smoking subjects there are 6 subjets (31.6%) with AFB conversion and 13 subjects (68.4% ) without AFB conversion. In the second month (p=0,202), more than half subjects who are non-smokers had AFB conversion, 17 subjects (89.5%) and 2 subjects (10.5%) had no AFB conversion. In smokers group there are 14 subjects (73.7% ) had AFB conversion and 5 subject (26.3%) had no conversion. Conclusion: There was a significant relation between smoking habit and the occurrence of first-month AFB sputum. (J Respir Indo. 2018; 38: 232-8)

scholarly journals Sex disparities in COVID-19 outcomes of inpatients with diabetes: insights from the CORONADO study

2021 ◽  
Author(s):  
Blandine Tramunt ◽  
Sarra Smati ◽  
Sandrine Coudol ◽  
Matthieu Wargny ◽  
Matthieu Pichelin ◽  
...  
Keyword(s):  
Microvascular Complications ◽  
Invasive Mechanical Ventilation ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Icu Admission ◽  
Female Sex ◽  
Patients With Diabetes ◽  
History Of ◽  
Biological Determinants ◽  
Stratified Analysis

Objective: Male sex is a determinant of severe coronavirus disease-2019 (COVID-19). We aimed to characterize sex differences in severe outcomes in adults with diabetes hospitalized for COVID-19. Methods: We performed a sex-stratified analysis of clinical and biological features and outcomes (i.e. invasive mechanical ventilation [IMV], death, intensive care unit [ICU] admission and home discharge at day 7 [D7] or day 28 [D28]) in 2,380 patients with diabetes hospitalized for COVID-19 and included in the nationwide CORONADO observational study (NCT04324736). Results: The study population was predominantly male (63.5%). After multiple adjustments, female sex was negatively associated with the primary outcome (IMV and/or death, OR 0.66 [0.49-0.88]), death (OR 0.49 [0.30-0.79]) and ICU admission (OR 0.57 [0.43-0.77]) at D7, but only with ICU admission (OR 0.58 [0.43-0.77]) at D28. Older age and a history of microvascular complications were predictors of death at D28 in both sexes, while chronic obstructive pulmonary disease (COPD) was predictive of death in women only. At admission, CRP, AST and eGFR predicted death in both sexes. Lymphocytopenia was an independent predictor of death in women only, while thrombocytopenia and elevated plasma glucose concentration were predictors of death in men only. Conclusions: In patients with diabetes admitted for COVID-19, female sex was associated with lower incidence of early severe outcomes, but did not influence the overall in-hospital mortality, suggesting that diabetes mitigates the female protection from COVID-19 severity. Sex-associated biological determinants may be useful to optimize COVID-19 prevention and management in women and men.

scholarly journals Association Between Male Sex and Outcomes of Coronavirus Disease 2019 (COVID-19)—A Danish Nationwide, Register-based Study

2020 ◽  
Author(s):  
Kristian Kragholm ◽  
Mikkel Porsborg Andersen ◽  
Thomas A Gerds ◽  
Jawad H Butt ◽  
Lauge Østergaard ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Risk Ratio ◽  
Cox Regression ◽  
Chronic Obstructive ◽  
Average Risk ◽  
Obstructive Pulmonary Disease ◽  
Icu Admission ◽  
Increased Risk ◽  
Male Sex ◽  
Artery Disease

Abstract Background and Objectives Male sex has been associated with severe coronavirus disease 2019 (COVID-19) infection. We examined the association between male sex and severe COVID-19 infection and if an increased risk remains after adjustment for age and comorbidities. Methods Nationwide register-based follow-up study of COVID-19 patients in Denmark until 16 May 2020. Average risk ratio comparing 30-day composite outcome of all-cause death, severe COVID-19 diagnosis or intensive care unit (ICU) admission for men versus women standardized to the age and comorbidity distribution of all patients were derived from multivariable Cox regression. Included covariates were age, hypertension, diagnoses including obesity, alcohol, sleep apnea, diabetes, chronic obstructive pulmonary disease, previous myocardial infarction (MI), ischemic heart disease (IHD), heart failure (HF), atrial fibrillation (AF), stroke, peripheral artery disease, cancer, liver, rheumatic, and chronic kidney disease (CKD). Results Of 4842 COVID-19 patients, 2281 (47.1%) were men. Median age was 57 [25%–75% 43–73] for men versus 52 [38–71] for women (P < .001); however, octogenarians had equal sex distribution. Alcohol diagnosis, diabetes, hypertension, sleep apnea, prior MI and IHD (all P < .001) as well as AF, stroke, and HF (all P = .01) were more often seen in men, and so was CKD (P = .03). Obesity diagnosis (P < .001) were more often seen in women. Other comorbidity differences were insignificant (P > .05). The fully adjusted average risk ratio was 1.63 [95% CI, 1.44–1.84]. Conclusions Men with COVID-19 infection have >50% higher risk of all-cause death, severe COVID-19 infection, or ICU admission than women. The excess risk was not explained by age and comorbidities.

Sign in / Sign up

Export Citation Format

Share Document