scholarly journals Outcomes of COPD Exacerbations Treated with Corticosteroids, Antibiotics, or Both

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Christopher B. Remakus ◽  
Francis Cordova ◽  
David Ciccolella ◽  
A. James Mamary ◽  
Matthew R. Lammi ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Standard Treatment ◽  
Peak Flow ◽  
Daily Diary ◽  
Symptom Index ◽  
Peak Flows ◽  
Copd Exacerbations ◽  
Acute Exacerbations ◽  
Antibiotic Group ◽  
Trigger Algorithm

Background. The outcomes for outpatient treatment of acute exacerbations of COPD (AECOPD) are poorly described. Design. The results of a daily diary recording symptoms and peak flows were compiled into a severity score to trigger algorithm-based treatments and a symptom index to follow treatment response. Treatment failure (symptom index failing to return to baseline for 2 consecutive days or hospitalization within 21 days) was the main outcome. Results. Twenty-two patients (FEV1 0.81 ± 0.26 L) were treated for 115 AECOPDs (corticosteroids = 36, antibiotics = 41, corticosteroids/antibiotics = 38). Treatment failure was 50% for the corticosteroid/antibiotic compared to 28% () for the corticosteroid and 34% () for the antibiotic group. Patients suffering from AECOPDs treated with corticosteroids had dyspnea, wheezing, and decreased peak flow; those treated with antibiotics had sputum symptoms; those treated with corticosteroids/antibiotics had dyspnea, wheezing, sputum symptoms, and decreased peak flows. Conclusions. AECOPDs with both dyspnea and sputum symptoms are more refractory to standard treatment and likely require closer monitoring.

Rainfall Events as Paths of a Stochastic Process: Problems of Design Storm Analysis

1984 ◽  
Vol 16 (8-9) ◽  
pp. 131-138 ◽  
Author(s):  
Johannes Brummer
Keyword(s):  
Stochastic Process ◽  
Peak Flow ◽  
Rainfall Events ◽  
Peak Flows ◽  
Design Storm ◽  
Adequate Evaluation ◽  
Rainfall Patterns

Problems in the construction of design storms are expressed in mathematical terms. Introduced here is a concept for approximating natural peak flow values by means of the distribution of typical rainfall patterns. A comparison demonstrates the quality of this concept and the competency of some well-known design storms for the adequate evaluation of peak flows.

scholarly journals COVID-19 public health measures: a reduction in hospital admissions for COPD exacerbations

Thorax ◽  
2020 ◽  
pp. thoraxjnl-2020-216083
Author(s):  
Jing Yuan Tan ◽  
Edwin Philip Conceicao ◽  
Liang En Wee ◽  
Xiang Ying Jean Sim ◽  
Indumathi Venkatachalam
Keyword(s):  
Public Health ◽  
Clinical Outcomes ◽  
Hospital Admissions ◽  
Viral Infections ◽  
Significant Morbidity ◽  
Common Cause ◽  
Copd Exacerbations ◽  
Health Measures ◽  
Acute Exacerbations ◽  
Respiratory Viral Infections

Hospitalisations for acute exacerbations of COPD (AECOPD) carry significant morbidity and mortality. Respiratory viral infections (RVIs) are the most common cause of AECOPD and are associated with worse clinical outcomes. During the COVID-19 pandemic, public health measures, such as social distancing and universal masking, were originally implemented to reduce transmission of SARS-CoV-2; these public health measures were subsequently also observed to reduce transmission of other common circulating RVIs. In this study, we report a significant and sustained decrease in hospital admissions for all AECOPD as well as RVI-associated AECOPD, which coincided with the introduction of public health measures during the COVID-19 pandemic.

scholarly journals Development and content validity of a gastroparesis cardinal symptom index daily diary

2009 ◽  
Vol 30 (6) ◽  
pp. 670-680 ◽  
Author(s):  
D. A. REVICKI ◽  
M. CAMILLERI ◽  
B. KUO ◽  
N. J. NORTON ◽  
L. MURRAY ◽  
...  
Keyword(s):  
Content Validity ◽  
Daily Diary ◽  
Symptom Index ◽  
Cardinal Symptom

scholarly journals Combination antibiotic therapy versus monotherapy in the treatment of acute exacerbations of chronic obstructive pulmonary disease: an open-label randomized trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Phuong Nguyen Thi Thu ◽  
Minh Ngo Thị Huong ◽  
Ngan Tran Thi ◽  
Hoi Nguyen Thanh ◽  
Khue Pham Minh
Keyword(s):  
Clinical Success ◽  
Chronic Obstructive ◽  
Gram Negative Bacteria ◽  
Beta Lactam ◽  
Open Label ◽  
Obstructive Pulmonary Disease ◽  
Gram Negative ◽  
Copd Exacerbations ◽  
Beta Lactam Antibiotics ◽  
Acute Exacerbations

Abstract Background The role of antibiotics in the treatment of chronic obstructive pulmonary disease (COPD) exacerbations and their effectiveness in combination have not been clearly established. To determine whether using a combination of fluoroquinolones and beta-lactams improves the clinical and microbiological efficacy of antibiotics on day 20 of treatment, we conducted an open-label randomized trial based on clinical outcomes, microbiological clearance, spirometry tests, and signs of systemic inflammation in patients hospitalized with acute exacerbations of COPD. Methods We enrolled 139 subjects with COPD exacerbations, defined as acute worsening of respiratory symptoms leading to additional treatment. Patients were divided randomly into two groups: 79 patients using beta-lactam antibiotics alone and 60 using beta-lactam antibiotics plus fluoroquinolones. Clinical and microbiological responses, spirometry tests, symptom scores, and serum C-reactive protein (CRP) levels were evaluated. Results Clinical success, lung function, and symptoms were similar in patients with or without fluoroquinolone administration on days 10 and 20. Combination therapy was superior in terms of microbiological outcomes and reduction in serum CRP value. Although equivalent to monotherapy in terms of clinical success, the combination showed superiority in terms of microbiological success and a decrease in CRP. The combination therapy group had a higher microbiological success rate with gram-negative bacteria than the monotherapy group with Pseudomonas aeruginosa (100% vs. 33.3%, respectively) and Acinetobacter baumanii (100% vs. 20%, respectively) (P < 0.05). Conclusions Concomitant use of fluoroquinolone and beta-lactam antibiotics for bacterial infections during COPD exacerbations caused by gram-negative bacteria appear to be effective and should be applied in clinical practice.

scholarly journals Possibility of Using Selected Rainfall-Runoff Models for Determining the Design Hydrograph in Mountainous Catchments: A Case Study in Poland

Water ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1450 ◽  
Author(s):  
Dariusz Młyński ◽  
Andrzej Wałęga ◽  
Leszek Książek ◽  
Jacek Florek ◽  
Andrea Petroselli
Keyword(s):  
Catchment Area ◽  
Peak Flow ◽  
Rainfall Runoff ◽  
Peak Flows ◽  
Mountainous Catchment ◽  
Mountainous Catchments ◽  
Relative Errors ◽  
Runoff Hydrographs

The aim of the study was to analyze the possibility of using selected rainfall-runoff models to determine the design hydrograph and the related peak flow in a mountainous catchment. The basis for the study was the observed series of hydrometeorological data for the Grajcarek catchment area (Poland) for the years 1981–2014. The analysis was carried out in the following stages: verification of hydrometeorological data; determination of the design rainfall; and determination of runoff hydrographs with the following rainfall-runoff models: Snyder, NRCS-UH, and EBA4SUB. The conducted research allowed the conclusion that the EBA4SUB model may be an alternative to other models in determining the design hydrograph in ungauged mountainous catchments. This is evidenced by the lower values of relative errors in the estimation of peak flows with an assumed frequency for the EBA4SUB model, as compared to Snyder and NRCS-UH.

Performance, environmental and cost comparisons of onsite detention (OSD) and onsite retention (OSR) in re-developed residential catchments

1999 ◽  
Vol 39 (2) ◽  
pp. 33-41 ◽  
Author(s):  
Peter Scott ◽  
Ruben Santos ◽  
John R. Argue
Keyword(s):  
Peak Flow ◽  
Storm Runoff ◽  
Environmental Benefits ◽  
Flood Wave ◽  
Environmental Aspects ◽  
Urban Flood ◽  
Peak Flows ◽  
Temporary Storage ◽  
Urban Catchments ◽  
Global Peak

On-site detention (OSD) of storm runoff decreases catchment peak flows through the routing effect of temporary storage; on-site retention (OSR) achieves the same objective by abstracting part of the urban flood wave and passing the retained water to disposal on site. The investigation explored both strategies applied to a set of hypothetical present/re-developed urban catchments ranging in size from 14 ha to 210 ha. Comparisons were made on the basis of site storage required (SSR) to achieve the same global peak flow reductions, environmental aspects and cost. OSR practice was shown to out-perform OSD generally in medium-large catchments with respect to SSR and, hence, cost. The retention option also has clear environmental benefits that fall beyond the scope normally ascribed to OSD practice. The paper cautions against use of OSR in unsuitable circumstances.

scholarly journals Influence of age on real-life effects of doxycycline for acute exacerbations among COPD outpatients: a population-based cohort study

2020 ◽  
Vol 7 (1) ◽  
pp. e000535
Author(s):  
Yuanyuan Wang ◽  
Jens H Bos ◽  
H Marike Boezen ◽  
Jan-Willem C Alffenaar ◽  
J F M van Boven ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cohort Study ◽  
Treatment Failure ◽  
Pulmonary Disease ◽  
Reference Group ◽  
Advanced Age ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Acute Exacerbations ◽  
Oral Corticosteroids

IntroductionAlthough bacteria contribute significantly to acute exacerbations of chronic obstructive pulmonary disease (AECOPD), the added value of antibiotics remains controversial, especially in outpatient settings. Age may affect antibiotic effectiveness, but real-world evidence is lacking. We aimed to assess the influence of age on the effectiveness of doxycycline for AECOPD.MethodsA retrospective cohort study among outpatients with the first recorded AECOPD treated with oral corticosteroids was conducted using a large pharmacy dispensing database. The primary outcome was treatment failure within 15–31 days after treatment start. Secondary outcome was time to second exacerbation. All analyses were stratified by age groups.ResultsWe identified 6300 outpatients with the first AECOPD. 2261 (36%) received doxycycline and 4039 (64%) did not receive any antibiotic (reference group). Overall, there was no difference in treatment failure (adjusted OR: 0.97, 95% CI: 0.84 to 1.12) between two groups. Similarly, no difference in treatment failure was observed in younger groups. However, in patients with advanced age (≥75 years), treatment failure was significantly reduced by doxycycline compared with reference (16% vs 20%, adjusted OR: 0.77, 95% CI: 0.62 to 0.97). Overall, median time to second exacerbation was 169 days (95% CI: 158 to 182 days) in doxycycline group compared with 180 days (95% CI: 169 to 191 days) in reference group (adjusted HR: 1.06, 95% CI: 0.99 to 1.12). Although in older patients there was a trend within 3 months towards longer time of next exacerbation by doxycycline, it did not achieve statistical significance.ConclusionsOur findings showed short-term treatment benefit of doxycycline added to oral corticosteroids for chronic obstructive pulmonary disease patients with advanced age. This value remains unclear for persons aged under 75 years in current primary care. Long-term preventive benefits of doxycycline for the next exacerbation were not observed, irrespective of age.

Sign in / Sign up

Export Citation Format

Share Document