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Effect of Bronchodilation, Exercise Training, and Behavior Modification on Symptoms and Physical Activity in ChronicObstructivePulmonaryDisease Bronchodilation and exercise training (ExT) improve exercise tolerance in patients with chronicobstructivepulmonarydisease (COPD); however, behavior modification is required to impact daily physical activity (PA).To assess whether tiotropium/olodaterol, with or without ExT, would improve exercise endurance time (EET) and PA compared with placebo (...) in patients participating in a self-management behavior-modification (SMBM) program.This was a 12-week, randomized, partially double-blind, placebo-controlled, parallel-group trial in patients with COPD (PHYSACTO; NCT02085161). All patients were enrolled into SMBM and randomized 1:1:1:1 to once-daily placebo, tiotropium 5 μg, tiotropium/olodaterol 5/5 μg, or tiotropium/olodaterol 5/5 μg plus 8 weeks ExT. EET, measured by endurance shuttle walk test after 8 weeks, was the primary endpoint. Additional
Budesonide/formoterol MDI with co-suspension delivery technology in COPD: the TELOS study TELOS compared budesonide (BD)/formoterol fumarate dihydrate (FF) metered dose inhaler (BFF MDI), formulated using innovative co-suspension delivery technology that enables consistent aerosol performance, with its monocomponents and budesonide/formoterol fumarate dihydrate dry powder inhaler (DPI) in patients with moderate to very severe chronicobstructivepulmonarydisease (COPD), without a requirement (...) assessed.BFF MDI 320/10 µg improved pre-dose trough FEV1versus FF MDI (least squares mean (LSM) 39 mL; p=0.0018), and BFF MDI 320/10 µg and 160/10 µg improved FEV1 AUC0-4versus BD MDI (LSM 173 mL and 157 mL, respectively; both p<0.0001) at week 24. BFF MDI 320/10 µg and 160/10 µg improved time to first and rate of moderate/severe exacerbations versus FF MDI. Treatments were well tolerated, with pneumonia incidence ranging from 0.5-1.4%.BFF MDI improved lung function versus monocomponents and exacerbations
and Global Initiative for ObstructiveLungDisease grade 1 to 2 who were living below 800 m. Patients were randomized to receive dexamethasone (8 mg/d) or placebo starting on the day before ascent and while staying in a high-altitude clinic at 3,100 m for 2 days. The primary outcome assessed during the altitude sojourn was the combined incidence of AMS/ARAHE, defined as an Environmental Symptoms Questionnaire cerebral score evaluating AMS ≥ 0.7 or ARAHE requiring descent or an intervention.In 60 patients (...) Efficacy of Dexamethasone in Preventing Acute Mountain Sickness in COPD Patients: Randomized Trial Patients with COPD may experience acute mountain sickness (AMS) and other altitude-related adverse health effects (ARAHE) when traveling to high altitudes. This study evaluated whether dexamethasone, a drug used for the prevention of AMS in healthy individuals, would prevent AMS/ARAHE in patients with COPD.This placebo-controlled, double-blind, parallel-design trial included patients with COPD
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
from the Cochrane Airways Trials Register and evaluated reference lists of included randomized controlled trials for additional studies. STUDY SELECTION Studies chosen were randomized controlled trials of noninvasive ventilation (inspiratory and expiratory support) to usual care in adult patients admitted to the hospital with acute exacerbations of chronicobstructivepulmonarydisease causing acute hypercapnic respiratory failure, de?ned as arterial pH less than 7.35 and mean PaCO 2 greater than (...) What Is the Utility of Noninvasive Ventilation in the Management of Acute Hypercapnic Respiratory Failure Associated With ChronicObstructivePulmonaryDisease? TAKE-HOME MESSAGE In patients with acute respiratory failure from chronicobstructivepulmonarydisease exacerbation, noninvasive ventilation reduces death and intubation compared with standard treatments. WhatIstheUtilityofNoninvasiveVentilationinthe Management of Acute Hypercapnic Respiratory Failure Associated With Chronic
improvement in the treated cohort compared to the control. Adverse events, occurring post procedure, included COPD exacerbations, haemoptysis, pneumothorax and pneumonia. In our centre we treated 30 patients, between January 2009 and February 2012, with variable improvement of lung function and only mild postoperative complications. The case we report here appears very interesting for the unusual near-fatal complication (massive alveolar haemorrage) followed by delayed strong functional improvement (FEV1 (...) Delayed functional improvement after near-fatal bleeding complication following endobronchial valve therapy for emphysema. Endoscopic treatment of emphysema is supported by different methods, including valves, coils and sealants. The mechanism is mainly related to volume reduction of targeted area. Endobronchial valves (EBV) appear the most studied method. In a multicentre randomised study, placement of unidirectional endobronchial valves resulted in a statistically significant functional
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
Preventing clinically important deterioration with single-inhaler triple therapy in COPD Clinically important deterioration (CID) is a novel composite end-point (lung function, health status, exacerbations) for assessing disease stability in patients with chronicobstructivepulmonarydisease (COPD). We prospectively analysed CID in the FULFIL study. FULFIL (ClinicalTrials.gov NCT02345161; randomised, double-blind, double-dummy, multicentre study) compared 24 weeks of once daily, single-inhaler (...) fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25 µg with twice daily budesonide/formoterol (BUD/FOR) 400/12 μg in patients aged ≥40 years with symptomatic advanced COPD (Global Initiative for ChronicObstructiveLungDisease group D). A subset of patients received study treatment for up to 52 weeks. Time to first CID event was assessed over 24 and 52 weeks using two approaches for the health status component: St George's Respiratory Questionnaire and COPD assessment test. FF/UMEC/VI
Telemonitoring in ChronicObstructivePulmonaryDisease (CHROMED). A Randomized Clinical Trial Early detection of chronicobstructivepulmonarydisease (COPD) exacerbations using telemonitoring of physiological variables might reduce the frequency of hospitalization.To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique and cardiac parameters in older patients with COPD and comorbidities.This multicenter, randomized clinical trial recruited 312 (...) patients with Global Initiative for ChronicObstructiveLungDisease grades II to IV COPD (median age, 71 yr [interquartile range, 66-76 yr]; 49.6% grade II, 50.4% grades III-IV), with a history of exacerbation in the previous year and at least one nonpulmonary comorbidity. Patients were randomized to usual care (n = 158) or telemonitoring (n = 154) and followed for 9 months. All telemonitoring patients self-assessed lung mechanics daily, and in a subgroup with congestive heart failure (n = 37) cardiac
airways (tracheostomy patients). Other features of myAIRVO2 are that it allows clinicians to titrate flow (from 10 to 60 litres/min on adult mode) and oxygen independently from one another and does not need a sealed interface. The product is marketed as AIRVO2 and myAIRVO2. myAIRVO2 is a device that is being used in the home or other domiciliary care environment. This briefing focuses on myAIRVO2 delivering nasal high-flow therapy for treating chronicobstructivepulmonarydisease (COPD), including (...) in a community setting. Innovations myAIRVO2 differs from standard respiratory gas devices in being designed to allow the delivery of nasal high-flow therapy in a community setting. It also uses room air, removing the need for piped medical air, and humidifies the delivered air to reduce the risk of dryness and trauma to the upper airway mucosa. Current care pathway The NICE guideline on chronicobstructivepulmonarydisease recommends treatment options including smoking cessation, inhaled therapy, oral
Patient-facing Technology for Identification of COPD in Primary Care. The proliferation of mobile devices and emergence of interoperable 'mHealth' apps is accelerating development and deployment of patient-facing risk assessments in primary care. The present study describes a user-centered design and an agile development approach to creation of an app for assessing lungfunction as part of a randomized controlled trial for the dentification of chronicobstructivelungdisease in primary (...) care.Seventeen patients recruited from a hospital-based, ambulatory family medicine clinic agreed to be videotaped while using the app, Lung Age, on a first-generation iPad prior to their provideR encounter. Subsequently, participants were interviewed using a semi-structured interview guide upon exiting their medical visit.Observational data indicated that participants took advantage of the portability and flexibility of the tablet device in the exam room to engage with the Lung Age app with the optionto
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.
with chronicobstructivepulmonarydisease (COPD).This 26-week, randomized, double-blind, triple-dummy study assessed the direct change from long-term triple therapy to indacaterol/glycopyrronium (110/50 μg once daily) or continuation of triple therapy (tiotropium [18 μg] once daily plus combination of salmeterol/fluticasone propionate [50/500 μg] twice daily) in nonfrequently exacerbating patients with moderate-to-severe COPD. Primary endpoint was noninferiority on change from baseline in trough FEV1 (...) Long-Term Triple Therapy De-escalation to Indacaterol/Glycopyrronium in Patients with ChronicObstructivePulmonaryDisease (SUNSET): A Randomized, Double-Blind, Triple-Dummy Clinical Trial There are no studies on withdrawal of inhaled corticosteroids in patients on long-term triple therapy in the absence of frequent exacerbations.To evaluate the efficacy and safety of direct de-escalation from long-term triple therapy to indacaterol/glycopyrronium in nonfrequently exacerbating patients
Effects of upper limb resistance exercise on aerobic capacity, muscle strength, and quality of life in COPD patients: a randomized controlled trial To evaluate the effects of upper limb resistance exercise on the functional capacity, muscle function, and quality of life in patients with chronicobstructivepulmonary disease.Clinical School of Physiotherapy in a Public University of Brazil.58 patients were recruited; of these, 7 were excluded and 51 individuals were enrolled.Control group (...) performed warm-up, aerobic exercise, inspiratory muscle training, and session stretching, followed by massage therapy. The treatment group performed warm-up, aerobic exercise, inspiratory muscle training, three sets of upper limb resistance exercise, and session stretching, followed by massage therapy. Total three sessions per week for eight weeks.6-minute walk test, respiratory and peripheral muscle strength, dyspnea, and quality of life. Normality of the data was tested using the Shapiro-Wilk test
Impact of coexistent chronicobstructivepulmonarydisease on the survival of patients with small cell lung cancer receiving chemotherapy While there is growing interest in the correlation between chronicobstructivepulmonarydisease (COPD) and non-small cell lung cancer, very few studies have examined the interaction between COPD and small cell lung cancer (SCLC). Therefore, the aim of this study was to examine the impact of COPD on the survival of patients with SCLC.The medical records (...) of 110 patients with SCLC who received chemotherapy from July 2006 until April 2014 were retrospectively examined. The overall survival (OS) and progression-free survival (PFS) rates of spirometry-diagnosed COPD and non-COPD groups were compared. Predictors for poorer survival were analyzed using Cox proportional hazards regression.Of the 110 SCLC patients, 57 (51.8%) had coexistent COPD. The median OS for the COPD group was 11.6 months and for the non-COPD group was 11.2 months (log-rank test, P
Determinants and outcomes of change in physical activity in COPD Determinants of change in physical activity and outcomes of physical activity promotion are unclear. In this secondary analysis of a randomised controlled trial of a physical activity intervention, we assess predictors of change in physical activity and the effects of increasing physical activity on chronicobstructivepulmonarydisease (COPD) measures. Physical activity was promoted in 94 subjects with COPD using the Omron HJ (...) day). Linear regression models explored predictors of change in physical activity and assessed the effect of response on changes in COPD measures. The cohort of responders (n=62) and nonresponders (n=32) had mean FEV1 1.89±0.64 L (63±22% predicted). Baseline steps per day, diagnosis of depression, social support, oxygen use and season significantly predicted change in daily step count. Responders had increases in physical activity (2038 steps per day), FEV1 (308 mL) and 6MWT distance (43.6 m
Circulating eosinophil levels do not predict severe exacerbations in COPD: a retrospective study Whether the level of circulating eosinophils in chronicobstructivepulmonarydisease (COPD) patients can predict the risk of exacerbations of COPD (ECOPD) or response to treatment is debated. Here, we evaluate the prevalence of elevated eosinophils in COPD patients and its relationship with severe ECOPD requiring hospitalisation. We retrospectively reviewed the charts of COPD patients hospitalised (...) patients, 121 had one or more ECOPD during the year after the index event. The prevalence of eosinophils ≥2% was 72% in ECOPD patients and 71% in controls (p=0.93). Among ECOPD patients, eosinophil levels ≥2%, ≥4% or ≥300 cells·μL-1, either when clinically stable or during hospitalisation, did not show a significant association with the rate of recurrent severe exacerbations. The severity of airflowlimitation was associated with recurrent exacerbations, but inhaled corticosteroid treatment
exacerbations : a European Respiratory Society/American Thoracic Society guideline Jadwiga A. Wedzicha (ERS co-chair) , Marc Miravitlles , John R. Hurst , Peter M.A (...) of chronicobstructivepulmonarydisease ( COPD ) exacerbations . Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach (...) Week 08, Ovid 2011 12. Management of COPD exacerbations : a European Respiratory Society/American Thoracic Society guideline. This document provides clinical recommendations for treatment of chronicobstructivepulmonarydisease ( COPD ) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development
according to the progression of the disease. Chronicobstructivepulmonarydisease or COPD is a chronic inflammation of the respiratory tract, with the gradual and partially irreversible deterioration of the airways. Patients generally suffer from a chronic cough 2016 14. 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 Chronicobstructivepulmonarydisease ( COPD ) is a disorder that is usually progressive, characterised by airflowlimitation that is not fully reversible. Sutherland ER, Cherniack RM. Management of chronicobstructivepulmonarydisease . 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
%(greaterunderstanding, con?dence etc.). Test retest Section A ICC range=0.87–0.96 7 Section B, Wilcoxon signed rank test (no difference) P.0.05 Cronbach’s a range=0.78– 0.95 De?nition of abbreviations: BCKQ=Bristol COPD Knowledge Questionnaire; COPD=chronicobstructivepulmonarydisease; COPD-Q=COPD Knowledge Questionnaire; ICC=intraclass correlation coef?cient; LINQ=Lung Information Needs Questionnaire; UCOPD=Understanding COPD questionnaire. WORKSHOP REPORT 772 AnnalsATS Volume 15 Number 7 | July 2018 content (...) COPDDisease Education in Pulmonary Rehabilitation: A Workshop Report WORKSHOPREPORT ChronicObstructivePulmonaryDisease Education in Pulmonary Rehabilitation An Of?cial American Thoracic Society/Thoracic Society of Australia and New Zealand/Canadian Thoracic Society/British Thoracic Society Workshop Report Felicity C. Blackstock, Suzanne C. Lareau, Linda Nici, Richard ZuWallack, Jean Bourbeau, Maria Buckley, StevenJ.Durning,TanjaW.Ef?ng,EllenEgbert,RogerS.Goldstein,William Kelly,AnnemarieLee