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Burden and clinical features of chronic obstructive pulmonary disease (COPD). Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality and represents a substantial economic and social burden throughout the world. It is the fifth leading cause of death worldwide and further increases in its prevalence and mortality are expected in the coming decades. The substantial morbidity associated with COPD is often underestimated by health-care providers (...) and patients; likewise, COPD is frequently underdiagnosed and undertreated. COPD develops earlier in life than is usually believed. Tobacco smoking is by far the major risk for COPD and the prevalence of the disease in different countries is related to rates of smoking and time of introduction of cigarette smoking. Contribution of occupational risk factors is quite small, but may vary depending on a country's level of economic development. Severe deficiency for alpha-1-antitrypsin is rare and the impact
Efficacy and safety of inhaled alpha1-antitrypsin in patients with severe alpha1-antitrypsin deficiency and frequent exacerbations of COPD Patients with inherited α1-antitrypsin (AAT) deficiency (ZZ-AATD) and severe chronic obstructive pulmonary disease (COPD) frequently experience exacerbations. We postulated that inhalation of nebulised AAT would be an effective treatment.We randomly assigned 168 patients to receive twice-daily inhalations of 80 mg AAT solution or placebo for 50 weeks (...) in the AAT-treated group and 2.67 in the placebo group (p=0.31). More patients receiving AAT reported treatment-related treatment-emergent adverse events compared to placebo (57.5% versus 46.9%, respectively) and they were more likely to withdraw from the study. After the first year of the study, when modifications to the handling of the nebuliser were introduced, the rate of safety events in the AAT-treated group dropped to that of the placebo group.We conclude that in AATD patients with severe COPD
CTS guideline on pharmacotherapy in patients with COPD— 2019 update of evidence Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=ucts20 Canadian Journal of Respiratory, Critical Care, and Sleep Medicine Revue canadienne des soins respiratoires et critiques et de la médecine du sommeil ISSN: 2474-5332 (Print) 2474-5340 (Online) Journal homepage: https://www.tandfonline.com/loi/ucts20 Canadian Thoracic Society Clinical (...) Practice Guideline on pharmacotherapy in patients with COPD – 2019 update of evidence Jean Bourbeau, Mohit Bhutani, Paul Hernandez, Shawn D. Aaron, Meyer Balter, Marie-France Beauchesne, Anthony D’Urzo, Roger Goldstein, Alan Kaplan, François Maltais, Don D. Sin & Darcy D. Marciniuk To cite this article: Jean Bourbeau, Mohit Bhutani, Paul Hernandez, Shawn D. Aaron, Meyer Balter, Marie-France Beauchesne, Anthony D’Urzo, Roger Goldstein, Alan Kaplan, François Maltais, Don D. Sin & Darcy D. Marciniuk (2019
Comparative safety of biologic versus conventional synthetic DMARDs in rheumatoid arthritis with COPD: a real-world population study Abatacept, a biologic DMARD, was associated with respiratory adverse events in a small subgroup of RA patients with chronic obstructive pulmonary disease (COPD) in a trial. Whether this potential risk is specific to abatacept or extends to all biologics and targeted synthetic DMARDs (tsDMARDs) is unclear. We assessed the risk of adverse respiratory events (...) associated with biologic and tsDMARDs compared with conventional synthetic DMARDs (csDMARDs) among RA patients with concomitant COPD in a large, real-world cohort.We used a prevalent new-user design to study RA patients with COPD in the US-based MarketScan databases. New users of biologic DMARDs and/or tsDMARDs were matched on time-conditional propensity scores to new users of csDMARDs. Adverse respiratory events were estimated using Cox models comparing current use of biologic/tsDMARDs with csDMARDs.The
European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD While the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients.The (...) conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode.Managing hypercapnia may be an important intervention
Pharmacologic and Nonpharmacologic Therapies in Adult Patients With Exacerbation of COPD Pharmacologic and Nonpharmacologic Therapies in Adult Patients With Exacerbation of COPD: A Systematic Review Comparative Effectiveness Review Number 221 RComparative Effectiveness Review Number 221 Pharmacologic and Nonpharmacologic Therapies in Adult Patients With Exacerbation of COPD: A Systematic Review Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services (...) assistive technology may not be able to fully access information in this report. For assistance contact EPC@ahrq.gov. Suggested citation: Dobler CC, Morrow AS, Farah MH, Beuschel B, Majzoub AM, Wilson ME, Hasan B, Seisa MO, Daraz L, Prokop LJ, Murad MH, Wang Z. Pharmacologic and Nonpharmacologic Therapies in Adult Patients With Exacerbation of COPD: A Systematic Review. Comparative Effectiveness Review No. 221. (Prepared by the Mayo Clinic Evidence- based Practice Center under Contract No. 290-2015
Fluticasone furoate/umeclidinium/vilanterol (COPD) – Addendum to Commission A18-15 1 Translation of addendum A18-46 Fluticasone furoate/umeclidinium/vilanterol (COPD) – Addendum to Commission A18-15 (Version 1.0; Status: 26 July 2018). Please note: This translation is provided as a service by IQWiG to English-language readers. However, solely the German original text is absolutely authoritative and legally binding. Addendum 26 July 2018 1.0 Commission: A18-46 Version: Status: IQWiG Reports (...) – Commission No. A18-46 Fluticasone furoate/ umeclidinium/vilanterol (COPD) – Addendum to Commission A18-15 1 Addendum A18-46 Version 1.0 FF/UMEC/VI – Addendum to Commission A18-15 26 July 2018 Institute for Quality and Efficiency in Health Care (IQWiG) - i - Publishing details Publisher: Institute for Quality and Efficiency in Health Care Topic: Fluticasone furoate/umeclidinium/vilanterol (COPD) – Addendum to Commission A18-15 Commissioning agency: Federal Joint Committee Commission awarded on: 09 July
Effect of Pulmonary Rehabilitation on Symptoms of Anxiety and Depression in COPD: A Systematic Review and Meta-Analysis Pulmonary rehabilitation (PR) improves exercise capacity and quality of life in people with COPD; however, its effect on anxiety and depression symptoms is less clear. Existing data are difficult to apply to clinical PR because of diverse interventions and comparators. This review evaluated the effectiveness of PR on anxiety and depression symptoms in people with COPD.A (...) systematic review and meta-analysis (PROSPERO CRD42018094172) was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on randomized controlled trials comparing PR (≥ 4 weeks' duration) with usual care. Four electronic databases were searched to February 2018 using terms related to COPD, PR, anxiety, and depression. Data were extracted by two assessors using standardized templates. Study quality was appraised via the PEDro scale, and evidence was rated
C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD).We performed a multicenter, open-label, randomized, controlled trial involving patients with a diagnosis of COPD in their primary care clinical record who consulted a clinician at 1 of 86 general medical (...) practices in England and Wales for an acute exacerbation of COPD. The patients were assigned to receive usual care guided by CRP point-of-care testing (CRP-guided group) or usual care alone (usual-care group). The primary outcomes were patient-reported use of antibiotics for acute exacerbations of COPD within 4 weeks after randomization (to show superiority) and COPD-related health status at 2 weeks after randomization, as measured by the Clinical COPD Questionnaire, a 10-item scale with scores ranging
In COPD puffers, does three-of-kind beat a pair? Tools for Practice is proudly sponsored by the Alberta College of Family Physicians (ACFP). ACFP is a provincial, professional voluntary organization, representing more than 3500 family physicians, family medicine residents and medical students in Alberta. Established over fifty years ago, the ACFP strives for excellence in family practice through advocacy, continuing medical education and primary care research. www.acfp.ca June 24, 2019 In COPD (...) puffers, does three-of-kind beat a pair? Clinical Question: In Chronic Obstructive Pulmonary Disease (COPD) patients on Long-Acting Muscarinic Antagonist (LAMA) and Long-Acting Beta-Agonist (LABA) dual therapy, does adding inhaled corticosteroids (ICS) improve outcomes? Bottom Line: In COPD patients with =1 exacerbation per year, triple therapy reduces the risk of future exacerbations compared to LAMA/LABA dual therapy (one less in 36 patients/year) but increases the risk of pneumonia (one more in 34
Oxygen compared to air during exercise training in COPD with exercise-induced desaturation Almost half the patients referred to pulmonary rehabilitation with chronic obstructive pulmonary disease (COPD) desaturate during exercise. Although oxygen supplementation may ameliorate oxygen desaturation, the effects on outcomes of exercise training have not been rigorously evaluated. This study aimed to determine whether supplemental oxygen during exercise training was more effective than medical air (...) in improving exercise capacity and health-related quality of life (HRQoL) in people with COPD.People with COPD who demonstrated oxygen desaturation <90% during the 6-min walk test were recruited to this multicentre trial with randomisation (independent, concealed allocation) to either an Oxygen group or Air group, blinding (participants, exercise trainers and European Respiratory Journal assessors) and intention-to-treat analysis. Both groups received the respective gas from concentrators via nasal prongs
Discriminative Accuracy of FEV1:FVC Thresholds for COPD-Related Hospitalization and Mortality. According to numerous current guidelines, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of the forced expiratory volume in the first second to the forced vital capacity (FEV1:FVC) of less than 0.70, yet this fixed threshold is based on expert opinion and remains controversial.To determine the discriminative accuracy of various FEV1:FVC fixed thresholds for predicting (...) COPD-related hospitalization and mortality.The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study harmonized and pooled data from 4 US general population-based cohorts (Atherosclerosis Risk in Communities Study; Cardiovascular Health Study; Health, Aging, and Body Composition Study; and Multi-Ethnic Study of Atherosclerosis). Participants aged 45 to 102 years were enrolled from 1987 to 2000 and received follow-up longitudinally through 2016.Presence of airflow obstruction, which
CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions The role of antibiotics in acute exacerbations of chronic obstructive pulmonary disease (COPD) is controversial and a biomarker identifying patients who benefit from antibiotics is mandatory. We performed a randomised, controlled trial in patients with acute exacerbations of COPD, comparing C-reactive protein (CRP)-guided antibiotic treatment to patient reported symptoms in accordance with the Global (...) Initiative for Chronic Obstructive Lung Disease (GOLD) strategy, in order to show a reduction in antibiotic prescription.Patients hospitalised with acute exacerbations of COPD were randomised to receive antibiotics based either on the GOLD strategy or according to the CRP strategy (CRP ≥50 mg·L-1).In total, 101 patients were randomised to the CRP group and 119 to the GOLD group. Fewer patients in the CRP group were treated with antibiotics compared to the GOLD group (31.7% versus 46.2%, p=0.028; adjusted
Benralizumab for the Prevention of COPD Exacerbations. The efficacy and safety of benralizumab, an interleukin-5 receptor alpha-directed cytolytic monoclonal antibody, for the prevention of exacerbations in patients with moderate to very severe chronic obstructive pulmonary disease (COPD) are not known.In the GALATHEA and TERRANOVA trials, we enrolled patients with COPD (at a ratio of approximately 2:1 on the basis of eosinophil count [≥220 per cubic millimeter vs. <220 per cubic millimeter (...) ]) who had frequent exacerbations despite receiving guideline-based inhaled treatment. Patients were randomly assigned to receive benralizumab (30 or 100 mg in GALATHEA; 10, 30, or 100 mg in TERRANOVA) every 8 weeks (every 4 weeks for the first three doses) or placebo. The primary end point was the treatment effect of benralizumab, measured as the annualized COPD exacerbation rate ratio (benralizumab vs. placebo) at week 56 in patients with baseline blood eosinophil counts of 220 per cubic millimeter
Effect of Aclidinium Bromide on Major Cardiovascular Events and Exacerbations in High-Risk Patients With Chronic Obstructive Pulmonary Disease: The ASCENT-COPD Randomized Clinical Trial. There is concern that long-acting muscarinic antagonists increase cardiovascular morbidity or mortality in patients with chronic obstructive pulmonary disease (COPD).To determine the cardiovascular safety (noninferiority) and efficacy (superiority) of aclidinium bromide, 400 μg twice daily, in patients (...) with COPD and cardiovascular disease or risk factors.Multicenter, randomized, placebo-controlled, double-blind, parallel-design study conducted at 522 sites in North America. A total of 3630 patients with moderate to very severe COPD and either a history of cardiovascular disease or at least 2 atherothrombotic risk factors were randomized; follow-up occurred for up to 3 years until at least 122 major adverse cardiovascular events (MACE) occurred. The first patient was enrolled on October 16, 2013
Adding a LAMA to ICS/LABA Therapy: A Meta-analysis of Triple Combination Therapy in COPD Inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) combination is commonly prescribed to treat COPD; therefore, we performed a meta-analysis on the effect of adding a long-acting muscarinic receptor antagonist (LAMA) to ICS/LABA combination in COPD.Studies were identified by searching in different databases the randomized controlled trials that investigated the effect of ICS/LABA/LAMA combination (...) in COPD. The primary end points were the effect of triple therapy on trough FEV1, risk of acute exacerbation of COPD (AECOPD), and risk of cardiovascular serious adverse events (SAEs), compared with ICS/LABA combination. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assess the quality of evidence.Thirteen randomized controlled trials including 15,519 patients with COPD (ICS/LABA/LAMA combination, 53.1%; ICS/LABA combination, 46.9%) were meta-analyzed. ICS
Dual bronchodilation with tiotropium/olodaterol further reduces activity-related breathlessness versus tiotropium alone in COPD The 3-min constant speed shuttle test (CSST) was used to examine the effect of tiotropium/olodaterol compared with tiotropium at reducing activity-related breathlessness in patients with chronic obstructive pulmonary disease (COPD).This was a randomised, double-blind, two-period crossover study including COPD patients with moderate to severe pulmonary impairment, lung (...) -min CSST from baseline with both tiotropium (mean -0.968, 95% CI -1.238- -0.698; n=100) and tiotropium/olodaterol (mean -1.325, 95% CI -1.594- -1.056; n=101). The decrease in breathlessness was statistically significantly greater with tiotropium/olodaterol versus tiotropium (treatment difference -0.357, 95% CI -0.661- -0.053; p=0.0217).Tiotropium/olodaterol reduced activity-related breathlessness more than tiotropium in dyspnoeic patients with moderate to severe COPD exhibiting lung
Glycopyrronium / formoterol fumarate dihydrate (Bevespi Aerosphere) - chronic obstructive pulmonary disease (COPD) EMA/752588/2018 EMEA/H/C/004245 Bevespi Aerosphere (glycopyrronium bromide / formoterol) An overview of Bevespi Aerosphere and why it is authorised in the EU What is Bevespi Aerosphere and what is it used for? Bevespi Aerosphere is a medicine used in adults to relieve the symptoms of chronic obstructive pulmonary disease (COPD). COPD is a long-term disease in which the airways (...) only be obtained with a prescription. For more information about using Bevespi Aerosphere, see the package leaflet or contact your doctor or pharmacist. How does Bevespi Aerosphere work? The two active substances in Bevespi Aerosphere work in different ways to widen the airways and improve breathing in COPD. Glycopyrronium bromide is a muscarinic receptor antagonist. This means that it blocks muscarinic receptors (targets) in muscle cells in the lungs. Because these receptors help control
Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials Randomised controlled trials (RCTs) of vitamin D to prevent COPD exacerbations have yielded conflicting results.Individual participant data meta-analysis could identify factors that explain this variation.PubMed, Embase, the Cochrane Central Register of Controlled Trials and Web of Science were searched from inception up to and including 5 October 2017 (...) to identify RCTs of vitamin D supplementation in patients with COPD that reported incidence of acute exacerbations. Individual participant data meta-analysis was performed using fixed effects models adjusting for age, sex, Global Initiative for Chronic Obstructive Lung Disease spirometric grade and trial.Four eligible RCTs (total 560 participants) were identified; individual participant data were obtained for 469/472 (99.4%) participants in three RCTs. Supplementation did not influence overall rate
Cluster-randomised trial of a nurse-led advance care planning session in patients with COPD and their loved ones Advance care planning (ACP) is uncommon in patients with chronic obstructive pulmonary disease (COPD).To assess whether a nurse-led ACP-intervention can improve quality of patient-physician end-of-life care communication in patients with COPD. Furthermore, the influence of an ACP-intervention on symptoms of anxiety and depression in patients and loved ones was studied. Finally (...) , quality of death and dying was assessed in patients who died during 2-year follow-up.A multicentre cluster randomised-controlled trial in patients with advanced COPD was performed. The intervention group received an 1.5 hours structured nurse-led ACP-session. Outcomes were: quality of patient-physician end-of-life care communication, prevalence of ACP-discussions 6 months after baseline, symptoms of anxiety and depression in patients and loved ones and quality of death and dying.165 patients were