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Association Between Long-term Exposure to Ambient Air Pollution and Change in Quantitatively Assessed Emphysema and Lung Function. While air pollutants at historical levels have been associated with cardiovascular and respiratorydiseases, it is not known whether exposure to contemporary air pollutant concentrations is associated with progression of emphysema.To assess the longitudinal association of ambient ozone (O3), fine particulate matter (PM2.5), oxides of nitrogen (NOx), and black carbon (...) exposure with change in percent emphysema assessed via computed tomographic (CT) imaging and lung function.This cohort study included participants from the Multi-Ethnic Study of Atherosclerosis (MESA) Air and Lung Studies conducted in 6 metropolitan regions of the United States, which included 6814 adults aged 45 to 84 years recruited between July 2000 and August 2002, and an additional 257 participants recruited from February 2005 to May 2007, with follow-up through November 2018.Residence-specific
Statins versus placebo for people with chronicobstructivepulmonarydisease. Chronicobstructivepulmonarydisease (COPD) is a common, preventable, and treatable respiratorydisease. COPD exacerbations are associated with worse quality of life, increased hospitalisations, and increased mortality. Currently available pharmacological interventions have variable impact on exacerbation frequency. The anti-inflammatory effects of statins may lead to decreased pulmonary and systemic inflammation (...) , resulting in fewer exacerbations of COPD. Several observational studies have shown potential benefits of statins for patients with COPD.This review aims to evaluate available evidence on benefits and harms associated with statin therapy compared with placebo as adjunct therapy for patients with COPD. Primary objectives include the following.• To determine whether statins reduce mortality rates in COPD.• To determine whether statins reduce exacerbation frequency, improve quality of life, or improve lung
2019CochraneControlled trial quality: predicted high
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 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
puffers, does three-of-kind beat a pair? Clinical Question: In ChronicObstructivePulmonaryDisease (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 (...) . 4. Cazzola M, Rogliani P, Calzetta L, et al. Eur Respir J. 2018; 52:1801586. 5. Ferguson GT, Rabe KF, Martinez FJ, et al. Lancet Respir. 2018; 6(10):747-58. 6. Global Initiative for ChronicObstructiveLungDisease. (2019). Global strategy for the diagnosis, management, and prevention of chronicobstructivepulmonarydisease. Available at https://goldcopd.org/gold-reports/ Accessed: May 11, 2019. 7. Magnussen H, Disse B, Rodriguez-Roisin R, et al. N Engl J Med. 2014; 371: 1285- 94. 8. Chapman KR
Oxygen compared to air during exercise training in COPD with exercise-induced desaturation Almost half the patients referred to pulmonary rehabilitation with chronicobstructivepulmonarydisease (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 (...) at 5 L·min-1 during exercise training consisting of treadmill and cycle exercise, three times per week for 8 weeks. Primary outcomes were the endurance shuttle walk test (ESWT) time and ChronicRespiratoryDisease Questionnaire (CRQ)-Total score.111 participants (60 males), mean±sd age 69±7 years, with moderate to severe COPD were recruited and 97 completed (Oxygen group n=52; Air group n=45). At the end of the 8-week training programme there were no between-group differences in change in ESWT
Discriminative Accuracy of FEV1:FVC Thresholds for COPD-Related Hospitalization and Mortality. According to numerous current guidelines, the diagnosis of chronicobstructivepulmonarydisease (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 airflowobstruction, which
Effect of Dexamethasone on Nocturnal Oxygenation in Lowlanders With ChronicObstructivePulmonaryDisease Traveling to 3100 Meters: A Randomized Clinical Trial During mountain travel, patients with chronicobstructivepulmonarydisease (COPD) are at risk of experiencing severe hypoxemia, in particular, during sleep.To evaluate whether preventive dexamethasone treatment improves nocturnal oxygenation in lowlanders with COPD at 3100 m.A randomized, placebo-controlled, double-blind, parallel trial (...) was performed from May 1 to August 31, 2015, in 118 patients with COPD (forced expiratory volume in the first second of expiration [FEV1] >50% predicted, pulse oximetry at 760 m ≥92%) who were living at altitudes below 800 m. The study was conducted at a university hospital (760 m) and high-altitude clinic (3100 m) in Tuja-Ashu, Kyrgyz Republic. Patients underwent baseline evaluation at 760 m, were taken by bus to the clinic at 3100 m, and remained at the clinic for 2 days and nights. Participants were
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
and procedure The condition, current treatments and procedure The condition 2.1 Emphysema is a chroniclungdisease that typically happens with chronicobstructivepulmonarydisease. In emphysema, the walls of the air sacs (alveoli) in the lungs weaken and disintegrate. This leaves behind abnormally large air spaces that stay filled with air even when the patient breathes out. The most common symptoms of emphysema are shortness of breath, coughing, fatigue and weight loss. Recurrent illnesses (such as chest (...) . Lung volume reduction surgery is an option for patients who experience breathlessness, and whose pulmonary function tests and CT scans show severe disease and enlarged air spaces. Surgery can be done thoracoscopically or using an open approach. Endoscopic lung volume reduction techniques include implanting valves or coils. The aim is to reduce the morbidity and mortality associated with conventional surgery. The procedure 2.3 Bronchoscopic thermal vapour (steam) ablation for upper-lobe emphysema
[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
Head-to-head oral prophylactic antibiotic therapy for chronicobstructivepulmonarydisease. Chronicobstructivepulmonarydisease (COPD; including chronic bronchitis and emphysema) is a chronicrespiratory condition characterised by shortness of breath, cough and recurrent exacerbations. Long-term antibiotic use may reduce both bacterial load and inflammation in the airways. Studies have shown a reduction of exacerbations with antibiotics in comparison to placebo in people with COPD (...) ).Overall, we judged the evidence presented to be of very low-certainty, mainly due to imprecision, but we also had concerns about indirectness and methodological quality of the included studies. The primary outcome measures for this review included exacerbations, quality of life, drug resistance and serious adverse events.Macrolide + tetracycline versus macrolide There was no clear difference between treatments in improvement in quality of life as assessed by the ChronicRespiratory Questionnaire (CRQ
Mucolytic agents versus placebo for chronic bronchitis or chronicobstructivepulmonarydisease. Individuals with chronic bronchitis or chronicobstructivepulmonarydisease (COPD) may suffer recurrent exacerbations with an increase in volume or purulence of sputum, or both. Personal and healthcare costs associated with exacerbations indicate that therapies that reduce the occurrence of exacerbations are likely to be useful. Mucolytics are oral medicines that are believed to increase (...) = 11; I² = 0%; moderate-certainty evidence).In participants with chronic bronchitis or COPD, we are moderately confident that treatment with mucolytics leads to a small reduction in the likelihood of having an acute exacerbation, in days of disability per month and possibly hospitalisations, but is not associated with an increase in adverse events. There appears to be limited impact on lung function or health-related quality of life. Results are too imprecise to be certain whether
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 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 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 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 (...) 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
Respiratory Research Network. Outcomes of patients with chronicobstructivepulmonarydisease diagnosed with or without pulmonary function testing . CMAJ 2017 ;189: E530 – E538 . , , 35 . Gershon AS , Thiruchelvam D , Chapman KR , Aaron SD , Stanbrook MB , Bourbeau J , et al .; Canadian Respiratory Research Network. Health services burden of undiagnosed and overdiagnosed COPD . Chest 2018 ;153: 1336 – 1346 . , , 36 . Wu H , Wise RA , Medinger AE . Do patients hospitalized with COPD have airflow (...) for ChronicObstructiveLungDisease. GOLD 2017: Global Strategy for the Diagnosis, Management and Prevention of COPD. Final revised 2017 Nov 20 [accessed 2017 Mar 12]. Available from: . 46 . Feemster LC , Au DH . Penalizing hospitals for chronicobstructivepulmonarydisease readmissions . Am J Respir Crit Care Med 2014 ;189: 634 – 639 . , , 47 . Sjoding MW , Cooke CR . Readmission penalties for chronicobstructivepulmonarydisease will further stress hospitals caring for vulnerable patient populations
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 chronicobstructivepulmonarydisease (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
to therapy. The diagnosis and treatment of COPD is rapidly changing, so understanding recent advances is important for the delivery of optimal patient care.Chronic obstructivepulmonarydisease is characterized by incompletely reversible expiratory airflowlimitation. Spirometry is the reference standard for diagnosing and assessing the severity of COPD. All patients should be counseled about and receive preventive measures such as smoking cessation and vaccination. Treatment should be guided (...) Diagnosis and Outpatient Management of ChronicObstructivePulmonaryDisease: A Review. There are 30 million adults (12%) in the United States who have chronicobstructivepulmonarydisease (COPD). Chronicobstructivepulmonarydisease accounts for 3.2% of all physician office visits annually and is the fourth leading cause of death (126 000 deaths per year). Most patients are diagnosed by their primary care clinicians who must address the highly variable clinical features and responses
People with chronicobstructivepulmonarydisease exacerbations prefer early discharge, then treatment at home. The studyHome treatment of COPD exacerbation 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.
Glycopyrronium / formoterol fumarate dihydrate (Bevespi Aerosphere) - chronicobstructivepulmonarydisease (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 chronicobstructivepulmonarydisease (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