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Core IM: Mind the Gap on COPD Classifications Core IM: Mind the Gap on COPD Classifications | Clinical Correlations Core IM: Mind the Gap on COPD Classifications February 14, 2018 Podcast: | Subscribe: | Let’s go deeper into to why we think about diseases the way we do: Classifications for COPD through the Years! Written by Dr. Steve Liu and Dr. Carolyn Drake || Hosted by Dr. Steve Liu, Dr. Carolyn Drake & Dr. Janine Knudsen || Graphic Design by Mr. Ramon Thompson Time Stamps How did prior (...) understanding of COPD pathophysiology lead to COPD classifications in the past? (3:25) How is COPD diagnosed? (6:13) How has COPD been classified and why? (6:42) Subscribe to CORE IM on any podcast app! Follow us on Facebook || Twitter || Instagram . Please give any feedback at . Show Notes : Chronic Obstructive Lung Disease (COPD) , is a disease of small airway inflammation defined by at FEV1/FVC ratio less than 0.70 and symptoms of chronic bronchitis and/or emphysema. In 1998, the U.S. National Heart
Effects of umeclidinium/vilanterol on exercise endurance in COPD: a randomised study Effects of umeclidinium/vilanterol on exercise endurance in COPD: a randomised study John H. Riley 1 , Chris J. Kalberg 2 , Alison Donald 2 , David A. Lipson 3,4 , Muhammad Shoaib 5 and Lee Tombs 6 Affiliations: 1 GlaxoSmithKline Respiratory Franchise, Brentford, UK. 2 Respiratory and Immuno-Inflammation, GlaxoSmithKline, Research Triangle Park, NC, USA. 3 Respiratory Clinical Development, GlaxoSmithKline, King (...) of umeclidinium/vilanterol (UMEC/VI) on exercise capacity in patients with chronic obstructive pulmonary disease (COPD) using the endurance shuttle walk test (ESWT). Patients were randomised 1:1 to one of two treatment sequences: 1) UMEC/VI 62.5/25 µg followed by placebo or 2) placebo followed by UMEC/VI 62.5/25 µg. Each treatment was taken once daily for 12 weeks. The primary end-point was 3-h post-dose exercise endurance time (EET) at week 12. Secondary end-points included trough forced expiratory volume in
COPDCOPD - Symptoms, diagnosis and treatment | BMJ Best Practice Search COPD Last reviewed: August 2018 Last updated: June 2018 Summary Progressive disease state characterised by airflow limitation that is not fully reversible. Suspected in patients with a history of smoking, occupational and environmental risk factors, or a personal or family history of chronic lung disease. Presents with progressive shortness of breath, wheeze, cough, and sputum production, including haemoptysis (...) . Diagnostic tests include PFTs, CXR, chest CT scan, oximetry, and ABG analysis. Patients should be encouraged to stop smoking or occupational exposure and be vaccinated against viral influenza and Streptococcus pneumoniae . Treatment options include bronchodilators, inhaled corticosteroids, and systemic corticosteroids. Long-term oxygen therapy improves survival in severe COPD. Definition COPD is a preventable and treatable disease state characterised by airflow limitation that is not fully reversible
Overview of COPD Overview of COPD - Summary of relevant conditions | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Overview of COPD Last reviewed: August 2018 Last updated: June 2018 Introduction Chronic obstructive pulmonary disease (COPD) is a disorder that is usually progressive, characterised by airflow limitation that is not fully reversible. Sutherland ER, Cherniack RM. Management of chronic obstructive pulmonary disease. N Engl J Med. 2004;350 (...) :2689-2697. http://www.ncbi.nlm.nih.gov/pubmed/15215485?tool=bestpractice.com Around 90% of cases of COPD are caused by cigarette smoking; other strong risk factors include more advanced age (may be related to longer period of smoking) and genetic factors (e.g., alpha-1 antitrypsin deficiency). Related conditions Condition Description Suspected in patients with a history of smoking, occupational/environmental risk factors, or a personal or family history of chronic lung disease. Presents
A simple algorithm for the identification of clinical COPD phenotypes 29097431 2017 11 03 1399-3003 50 5 2017 Nov The European respiratory journal Eur. Respir. J. A simple algorithm for the identification of clinical COPD phenotypes. 1701034 10.1183/13993003.01034-2017 This study aimed to identify simple rules for allocating chronic obstructive pulmonary disease (COPD) patients to clinical phenotypes identified by cluster analyses.Data from 2409 COPD patients of French/Belgian COPD cohorts were (...) analysed using cluster analysis resulting in the identification of subgroups, for which clinical relevance was determined by comparing 3-year all-cause mortality. Classification and regression trees (CARTs) were used to develop an algorithm for allocating patients to these subgroups. This algorithm was tested in 3651 patients from the COPD Cohorts Collaborative International Assessment (3CIA) initiative.Cluster analysis identified five subgroups of COPD patients with different clinical characteristics
Baseline Symptom Score Impact on Benefits of Glycopyrrolate/Formoterol Metered Dose Inhaler in COPD 28720336 2017 12 15 2017 12 15 1931-3543 152 6 2017 Dec Chest Chest Baseline Symptom Score Impact on Benefits of Glycopyrrolate/Formoterol Metered Dose Inhaler in COPD. 1169-1178 S0012-3692(17)31254-0 10.1016/j.chest.2017.07.007 The clinical severity of COPD is currently categorized by symptom burden and exacerbation risk. Previous 24-week phase III trials (NCT01854645 and NCT01854658 (...) ) that demonstrated better improvement of lung function with glycopyrrolate/formoterol fumarate (GFF) metered dose inhaler (MDI) (an MDI fixed-dose of GFF 18/9.6 μg) over individual monocomponent MDIs included a cross-section of patients with moderate to very severe airflow limitation and a broad range of COPD symptoms. These post hoc analyses of pooled data investigated whether baseline symptom burden, assessed using the COPD Assessment Test (CAT) score, impacted GFF MDI-associated improvements in lung function
Effect of erdosteine on the rate and duration of COPD exacerbations: the RESTORE study 29025888 2017 12 19 1399-3003 50 4 2017 Oct The European respiratory journal Eur. Respir. J. Effect of erdosteine on the rate and duration of COPD exacerbations: the RESTORE study. 1700711 10.1183/13993003.00711-2017 Oxidative stress contributes to chronic obstructive pulmonary disease (COPD) exacerbations and antioxidants can decrease exacerbation rates, although we lack data about the effect of such drugs (...) on exacerbation duration.The RESTORE (Reducing Exacerbations and Symptoms by Treatment with ORal Erdosteine in COPD) study was a prospective randomised, double-blind, placebo-controlled study, enrolling patients aged 40-80 years with Global Initiative for Chronic Obstructive Lung Disease stage II/III. Patients received erdosteine 300 mg twice daily or placebo added to usual COPD therapy for 12 months. The primary outcome was the number of acute exacerbations during the study.In the pre-specified intention
Natural history of COPD: gaps and opportunities Natural history of COPD: gaps and opportunities Alvar Agustí 1,2,3 and Bartolomé Celli 4 Number 1 in the series “Gaps in our understanding of COPD” Edited by A. Agustí and B. Celli Affiliations: 1 Respiratory Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain. 2 Institut d’Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain. 3 CIBER Enfermedades Respiratorias, Spain. 4 Brigham and Women’s Hospital, Harvard Medical (...) School, Boston, MA, USA. Correspondence: Alvar Agustí, Respiratory Institute, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain. E-mail: AAGUSTI@clinic.cat ABSTRACT Understanding the natural history of a disease is as important as knowing its cause(s) for effective disease prevention and treatment. Yet, our current understanding of the natural history of chronic obstructive pulmonary disease (COPD) is incomplete and often controversial. This article discusses the current gaps, and hence
The effectiveness of a nurse-led illness perception intervention in COPD patients: a cluster randomised trial in primary care The effectiveness of a nurse-led illness perception intervention in COPD patients: a cluster randomised trial in primary care Saskia W.M. Weldam 1 , Marieke J. Schuurmans 2 , Pieter Zanen 1 , Monique J.W.M. Heijmans 3 , Alfred P.E. Sachs 4 and Jan-Willem J. Lammers 1 Affiliations: 1 Dept of Respiratory Diseases, Division of Heart and Lungs, University Medical Center (...) Utrecht, HP E03.511, PO Box 85500, 3508 GA, Utrecht, The Netherlands. E-mail: S.Weldam@umcutrecht.nl ABSTRACT The new COPD-GRIP (Chronic Obstructive Pulmonary Disease – Guidance, Research on Illness Perception) intervention translates evidence regarding illness perceptions and health-related quality of life (HRQoL) into a nurse intervention to guide COPD patients and to improve health outcomes. It describes how to assess and discuss illness perceptions in a structured way. This study aimed to assess
Tiotropium (Spiriva Respimat) - as a maintenance bronchodilator treatment to relieve symptoms of patients with chronic obstructive pulmonary disease (COPD) Published 11 December 2017 Product Update tiotropium 2.5 microgram inhalation solution (Spiriva Respimat ® ) SMC No 411/07 Boehringer Ingelheim Ltd 10 November 2017 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use (...) in NHS Scotland. The advice is summarised as follows: ADVICE: following an abbreviated resubmission tiotropium (Spiriva Respimat ® ) is accepted for use within NHS Scotland. Indication under review: as a maintenance bronchodilator treatment to relieve symptoms of patients with chronic obstructive pulmonary disease (COPD). Tiotropium (Spiriva Respimat ® ) was previously accepted for restricted use in patients who have poor manual dexterity and therefore have difficulty using the HandiHaler device
A qualitative study of patients' experiences of participating in SPACE for COPD: a Self-management Programme of Activity, Coping and Education 29204434 2018 11 13 2312-0541 3 4 2017 Oct ERJ open research ERJ Open Res A qualitative study of patients' experiences of participating in SPACE for COPD: a Self-management Programme of Activity, Coping and Education. 00017-2017 10.1183/23120541.00017-2017 The aim of this study was to understand experiences of participation in a supported self-management (...) programme for chronic obstructive pulmonary disease (COPD). There is a wealth of clinical trials examining the outcomes of self-management interventions for individuals with COPD, but current understanding regarding patients' perspectives of such complex interventions is limited. Further insight may help to tailor self-management interventions and maximise patient engagement. Semi-structured interviews were conducted with individuals participating in a self-management programme, SPACE for COPD
Long-Acting β-Agonists (LABA) Combined With Long-Acting Muscarinic Antagonists or LABA Combined With Inhaled Corticosteroids for Patients With Stable COPD. Clinical Question: Are inhaled long-acting muscarinic antagonists (LAMA) combined with long-acting β-agonists (LABA) associated with differences in the incidence of chronic obstructive pulmonary disease (COPD) exacerbation and serious adverse events and with differences in quality of life and forced expiratory volume in the first second (...) of expiration (FEV1) vs inhaled LABA plus inhaled corticosteroids therapy for the treatment of stable COPD? Bottom Line: Compared with inhaled LABA combined with corticosteroids, inhaled LAMA combined with LABA may be associated with a lower risk of COPD exacerbation and with greater improvement in FEV1 without differences in the incidence of serious severe adverse events or quality of life.
Beclometasone dipropionate anhydrous/formoterol fumarate dihydrate/glycopyrronium bromide (Trimbow) - Maintenance treatment in adult patients with moderate to severe chronic obstructive pulmonary disease (COPD) Published 09 October 2017 Product Update: beclometasone dipropionate / formoterol fumarate dihydrate / glycopyrronium 87 micrograms / 5 micrograms / 9 micrograms metered dose inhaler (Trimbow ® ) SMC No 1274/17 Chiesi Limited 08 September 2017 The Scottish Medicines Consortium (SMC) has (...) with moderate to severe chronic obstructive pulmonary disease (COPD) who are not adequately treated by a combination of an inhaled corticosteroid and a long-acting beta2-agonist. SMC restriction: severe COPD (forced expiratory volume in one second less than 50% predicted normal). Trimbow costs less than inhalers containing beclometasone dipropionate / formoterol fumarate 100 micrograms/ 6 micrograms and glycopyrronium 44 micrograms administered separately. Advice context: No part of this advice may be used
Asthma-COPD overlap syndrome: pathogenesis, clinical features, and therapeutic targets. Asthma-COPD overlap syndrome (ACOS) or asthma-COPD overlap captures the subset of patients with airways disease who have features of both asthma and chronic obstructive pulmonary disease (COPD). Although definitions of ACOS vary, it is generally thought to encompass persistent airflow limitation in a patient older than 40 years of age with either a history of asthma or large bronchodilator reversibility (...) . ACOS affects about a quarter of patients with COPD and almost a third of patients who previously had asthma. Compared with their counterparts with asthma or COPD alone, patients with ACOS have significantly worse respiratory symptoms, poorer quality of life, and increased risk of exacerbations and hospital admissions. Whether this condition emerges after gradual shifts in airway remodelling and inflammation in a patient with COPD, as the result of noxious exposures in a patient with asthma, or even
Spiolto Respimat (tiotropium/olodaterol) - chronic obstructive pulmonary disease (COPD) Spiolto Respimat® (tiotropium/olodaterol) × Insert searchphrase to search the website Insert searchphrase to search the website > > > Spiolto Respimat® (tiotropium/olodaterol) Conclusion Spiolto Respimat® (tiotropium/olodaterol) combines a long-acting muscarinic antagonist (LAMA) with a long-acting beta agonist (LABA) and is approved for maintenance bronchodilator treatment to relieve symptoms in adult (...) patients with chronic obstructive pulmonary disease (COPD). The LAMA component, tiotropium (Spiriva®), and the LABA component, olodaterol (Striverdi®), each have the same indication as Spiolto Respimat®. Despite statistically significant differences in several patient-specific measures of effectiveness (e.g. quality of life) favouring Spiolto Respimat® over the individual components, the efficacy is assessed to have limited clinical relevance in patients not yet started on relevant symptom-alleviating
Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits 28546268 2017 05 26 2017 05 26 1399-3003 49 5 2017 May The European respiratory journal Eur. Respir. J. Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits. 1602129 10.1183/13993003.02129-2016 Pulmonary rehabilitation (PR) remains grossly underutilised by suitable (...) patients worldwide. We investigated whether home-based maintenance tele-rehabilitation will be as effective as hospital-based maintenance rehabilitation and superior to usual care in reducing the risk for acute chronic obstructive pulmonary disease (COPD) exacerbations, hospitalisations and emergency department (ED) visits.Following completion of an initial 2-month PR programme this prospective, randomised controlled trial (between December 2013 and July 2015) compared 12 months of home-based