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Latest & greatest articles for copd exacerbations
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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 chronicobstructivepulmonarydisease (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 (...) . Patients used an electronic diary to capture exacerbations. The primary endpoint was time from randomisation to the first event-based exacerbation. Secondary endpoints included change in the nature of the exacerbation as defined by the Anthonisen criteria. Safety was also assessed.Time to first moderate or severe exacerbation was a median of 112 days (interquartile range (IQR) 40-211 days) for AAT and 140 days (IQR 72-142 days) for placebo (p=0.0952). The mean yearly rate of all exacerbations was 3.12
of Bias Appendix F. Results From Included Studies Appendix G. Results by Severity Appendix H. Adverse Events Appendix I. Inclusion and Exclusion Criteria of Included Studies Appendix J. Sensitivity Analysis Appendix K. Appendix References ES-1 Evidence Summary Background and Objectives Chronicobstructivepulmonarydisease (COPD) is a common respiratorydisease characterized by airflowlimitation and chronicrespiratory symptoms. The global prevalence is estimated to be greater than 10 percent (...) of experiencing exacerbations of COPD (ECOPD). There have been various definitions of what constitutes an ECOPD. The Global Initiative for chronicobstructivelungdisease (GOLD) defines ECOPD in its 2019 report as “acute worsening of respiratory symptoms that result in additional therapy.” 5 ECOPD is generally characterized by increased dyspnea, increased frequency and severity of cough, and/or increased sputum production. 6 ECOPD is a leading independent cause of increased mortality and morbidity among
C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPDExacerbations. 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 chronicobstructivepulmonarydisease (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
CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions The role of antibiotics in acute exacerbations of chronicobstructivepulmonarydisease (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 ChronicObstructiveLungDisease (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
[Effectiveness of a brief educational intervention relating to the correct use of inhalers on the prevention of exacerbation in patients suffering from chronicobstructivepulmonarydisease]. To predict the effect of a brief educational intervention aimed at improving the inhaler technique on the reduction of exacerbations in patients with COPD over a year.A triple blind, randomised controlled clinical trial with parallel design.to be between 40-75 years, having been diagnosed with COPD (...) of exacerbations in each group was checked.social and demographic, study, dyspnoea level, body-mass index, tobacco use, FEV1, FEV1/FVC, COPD stage, BODEX index, number, type, and inhaler technique, number of previous exacerbations. Bayesian inference analysis was performed using logistic regression models.A total of 56 patients were assigned to de intervention group and 41 to the control one. There were 16 and 14 lost to follow-up, respectively. In the intervention group, 44.6% of the patients had
Benralizumab for the Prevention of COPDExacerbations. 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 chronicobstructivepulmonarydisease (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 COPDexacerbation 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 ChronicObstructivePulmonaryDisease: The ASCENT-COPD Randomized Clinical Trial. There is concern that long-acting muscarinic antagonists increase cardiovascular morbidity or mortality in patients with chronicobstructivepulmonarydisease (COPD).To determine the cardiovascular safety (noninferiority) and efficacy (superiority) of aclidinium bromide, 400 μg twice daily, in patients (...) %]), and upper respiratory tract infection (aclidinium, 86 events [4.8%]; placebo, 101 events [5.6%]).Among patients with COPD and increased cardiovascular risk, aclidinium was noninferior to placebo for risk of MACE over 3 years. The rate of moderate to severe COPDexacerbations was reduced over the first year.ClinicalTrials.gov Identifier: NCT01966107.
Can treating vitamin D deficiency reduce exacerbations of chronicobstructivepulmonarydisease? The studyJolliffe D, Greenberg L, Hooper R, Mathyssen C, Rafiq R, de Jongh R, Camargo C, Griffiths C, Janssens W, Martineau A. Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials. Thorax 2019. doi:10.1136/thoraxjnl-2018-212092This project was funded by the National Institute for Health Research Health (...) Technology Appraisal programme (project number 13/03/25).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000737/treating-vitamin-d-deficiency-may-reduce-exacerbations-of-copd.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
People with chronicobstructivepulmonarydiseaseexacerbations prefer early discharge, then treatment at home. The studyHome treatment of COPDexacerbation selected by DECAF score: a non-inferiority, randomised controlled trial and economic evaluationEchevarria C, Gray J, Hartley T, Miller J, Simpson AJ, Gibson GJ, Bourke SCPublished on 24 April 2018 Thorax 2018;73:713-22This project was funded by the National Institute for Health Research-Research for Patient Benefit Programme (project number (...) PB-PG-0213-30105).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000691/hospital-at-home-treatment-for-copd-flare-ups.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Capturing Exacerbations of ChronicObstructivePulmonaryDisease with EXACT. A Subanalysis of FLAME Chronicobstructivepulmonarydiseaseexacerbations accelerate lung function decline, reduce quality of life, and increase mortality. A subset of patients (n = 457) from the FLAME (Effect of Indacaterol Glycopyrronium vs. Fluticasone Salmeterol on COPDExacerbations) study used the Exacerbations of COPD Tool (EXACT) to capture symptom-defined exacerbations.To evaluate the effect of indacaterol (...) /glycopyrronium versus salmeterol/fluticasone on symptom-defined exacerbations measured using EXACT, and to assess differences between these events and exacerbations requiring healthcare resource use (HCRU).All patients in FLAME used an electronic diary to record and detect symptom deteriorations; HCRU-related exacerbations were confirmed by investigators. In patients using the EXACT questionnaire, the onset, recovery, and magnitude of symptom-defined exacerbations were identified by changes in total scores
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 ChronicObstructiveLungDisease 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 (...) 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 COPDexacerbations 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
-inflammatory effects of inhaled steroids and therefore could be useful for those who continue to suffer exacerbations and hospital admissions. However, the results of this study confirm guideline recommendations that, for the majority of people, the combination of oral theophylline plus inhaled steroid is not useful. Share your views on the research. Why was this study needed? Chronicobstructivepulmonarydisease (COPD) is a progressive lungdisease costing the NHS approximately £1 billion annually (...) ; updated 2016. Why was this study needed? Chronicobstructivepulmonarydisease (COPD) is a progressive lungdisease costing the NHS approximately £1 billion annually. Estimates vary, but it is thought over one million people are living with COPD in the UK. This figure is probably not a true reflection as many cases remain undiagnosed. There is no cure, but with maintenance treatment, the symptoms can be managed although many people still experience frequent exacerbations. Exacerbations are associated
People with COPDexacerbations prefer early discharge then treatment at home Hospital at home treatment for COPD flare-ups Discover Portal Discover Portal People with COPDexacerbations prefer early discharge then treatment at home Published on 11 December 2018 doi: People with flare-ups of COPD (chronicobstructivepulmonarydisease) prefer to be managed at home rather than in hospital. Hospital stay was on average four days shorter when people were discharged early to the hospital at home (...) in hospital which should probably give cost savings, although the hoped for benefit of a reduction in readmissions was not realised. Share your views on the research. Why was this study needed? Chronicobstructivepulmonarydisease (COPD) is the name of a group of lung disorders that cause increasing difficulty in breathing over time. Almost 2% of people in England have COPD, mostly middle aged or older long term smokers. COPD usually progresses slowly, but people can have sudden worsening known
of moderate aggravation in patients with chronicobstructivepulmonarydisease (COPD), it is preferable to prescribe antibiotics as a first-line treatment only when the suspicion of bacterial infection is reinforced by an increase in sputum purulence. Patients with chronicobstructivepulmonarydisease (COPD) are subject to exacerbations of their disease, i.e. episodes of prolonged aggravation. The known causes are mainly viral and bacterial infections. Some exacerbations justify hospitalisation: severe (...) COPD, rapid increase in respiratory signs, presence of associated diseases (e.g. diabetes, cardiovascular diseases). When exacerbation is moderate, the results of available trials show that seven out of ten patients recover in less than four weeks without antibiotics. About one in ten patients heals faster with antibiotic therapy, which may also extend the interval until the next exacerbation. Antibiotic therapies expose patients to the carrying of resistant bacteria, which are sources of harder
Inhaler Technique Education and Exacerbation Risk in Older Adults with Asthma or ChronicObstructivePulmonaryDisease: A Meta-Analysis To evaluate the effect of inhaler education programs on clinical outcomes and exacerbation rates in older adults with asthma or chronicobstructivepulmonarydisease (COPD).Systematic review and meta-analysis.Older adults with asthma or COPD, either in primary or secondary health care and pharmacy setting.We searched the Medline, Embase, and Central databases (...) according to the main eligibility criteria for inclusion: systematic reviews, meta-analysis, clinical trials and quasi-experimental studies; participants aged 65 and older; education on inhaler technique and reporting of disease control and exacerbation rates. We used the Grading of Recommendations, Assessment, Development and Evaluations scale for quality assessment and used a random-effect model with Mantel-Haenszel adjustment to perform a meta-analysis.We included 8 studies (4 randomized, 4 quasi
Nebulized terbutaline & ipratropium bromide vs terbutaline alone in acute exacerbation of COPD requiring noninvasive ventilation: a randomized double blind controlled trial Short-acting β2 -agonists are the mainstay of treatment of patients with acute exacerbation of chronicobstructivepulmonarydisease (AECOPD) in the emergency department (ED). It is still unclear whether the addition of short-acting anticholinergics is clinically more effective care compared to treatment with β2 -agonists (...) regarding baseline demographic and clinical characteristics. Hospital admission was observed in 70 patients (59.8%) in the terbutaline/IB group and in 75 patients (65.2%) in the terbutaline group (respiratory rate [RR] = 1.09, 95% confidence interval [CI] = 0.93 to 1.27, p = 0.39). ICU admission was required in 37 (32.2%) patients in the terbutaline/IB group and 30 patients (25.6%) in terbutaline group (RR = 1.25, 95% CI = 1.02 to 1.54, p = 0.27). There were no significant differences in dyspnea score
Antibiotics for exacerbations of chronicobstructivepulmonarydisease. Many patients with an exacerbation of chronicobstructivepulmonarydisease (COPD) are treated with antibiotics. However, the value of antibiotics remains uncertain, as systematic reviews and clinical trials have shown conflicting results.To assess effects of antibiotics on treatment failure as observed between seven days and one month after treatment initiation (primary outcome) for management of acute COPDexacerbations (...) , as well as their effects on other patient-important outcomes (mortality, adverse events, length of hospital stay, time to next exacerbation).We searched the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library, MEDLINE, Embase, and other electronically available databases up to 26 September 2018.We sought to find randomised controlled trials (RCTs) including people with acute COPDexacerbations comparing antibiotic therapy and placebo and providing follow-up of at least
Effect of Theophylline as Adjunct to Inhaled Corticosteroids on Exacerbations in Patients With COPD: A Randomized Clinical Trial. Chronicobstructivepulmonarydisease (COPD) is a major global health issue and theophylline is used extensively. Preclinical investigations have demonstrated that low plasma concentrations (1-5 mg/L) of theophylline enhance antiinflammatory effects of corticosteroids in COPD.To investigate the effectiveness of adding low-dose theophylline to inhaled corticosteroids (...) in COPD.The TWICS (theophylline with inhaled corticosteroids) trial was a pragmatic, double-blind, placebo-controlled, randomized clinical trial that enrolled patients with COPD between February 6, 2014, and August 31, 2016. Final follow-up ended on August 31, 2017. Participants had a ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) of less than 0.7 with at least 2 exacerbations (treated with antibiotics, oral corticosteroids, or both) in the previous year and were
Use of adjunct cardiovascular therapy in patients hospitalised for acute exacerbations of COPD In real-life practice, acute exacerbation of COPD is often treated as a cardiopulmonary syndrome http://ow.ly/uAnk30luMYz.