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Program of Integrated Care for Patients with Chronic Obstructive Pulmonary Disease and Multiple Comorbidities (PIC COPD(+)): a randomised controlled trial We sought to evaluate the effectiveness of a multi-component, case manager-led exacerbation prevention/management model for reducing emergency department visits. Secondary outcomes included hospitalisation, mortality, health-related quality of life, chronic obstructive pulmonary disease (COPD) severity, COPD self-efficacy, anxiety (...) and depression.Two-centre randomised controlled trial recruiting patients with ≥2 prognostically important COPD-associated comorbidities. We compared our multi-component intervention including individualised care/action plans and telephone consults (12-weekly then 9-monthly) with usual care (both groups). We used zero-inflated Poisson models to examine emergency department visits and hospitalisation; Cox proportional hazard model for mortality.We randomised 470 participants (236 intervention, 234 control
Long-term Use of Inhaled Corticosteroids in COPD and the Risk of Fracture It is uncertain whether long-term use of inhaled corticosteroids (ICSs), widely used to treat COPD, increases the risk of fracture, particularly in women, in view of the postmenopausal risks. We assessed whether long-term ICS use in patients with COPD increases the risk of hip or upper extremity fractures, and examined sex-related differences.The Quebec health-care databases were used to form a cohort of patients (...) with COPD over 1990 to 2005, followed until 2007 for the first hip or upper extremity fracture. In a nested case-control analysis, each case of fracture was matched with 20 control subjects on age, sex, and follow-up time. The adjusted rate ratio (RR) of fracture with ICS use, by duration and dose, was estimated using conditional logistic regression, with an interaction term to compare the risk in men and women.In the cohort of 240,110 subjects, 19,396 sustained a fracture during a mean 5.3 years (rate
COPD: time to improve its taxonomy? Due to well-conducted epidemiological studies and advances in genetics, molecular biology, translational research, the advent of computed tomography of the lungs and bioinformatics, the diagnosis of chronic obstructive pulmonary disease (COPD) as a single entity caused by susceptibility to cigarette smoke is no longer tenable. Furthermore, the once-accepted concept that COPD results from a rapid and progressive loss of lung function over time is not true (...) for a sizeable proportion of adults with the disease. Now we know that some genetic predisposition and/or different environmental interactions (nutritional, infectious, pollution and immunological) may negatively modulate post-natal lung development and lead to poorly reversible airflow limitation later in life, consistent with COPD. We believe it is time to rethink the taxonomy of this disease based on the evidence at hand. To do so, we have followed the principles outlined in the 1980s by J.D. Scadding who
Do-not-resuscitate orders as part of advance care planning in patients with COPD There is growing awareness of the need for advance care planning in patients with chronic obstructive pulmonary disease (COPD). However, do-not-resuscitate (DNR) order implementation remains a challenge in clinical practice. We retrospectively analysed an observational cohort of 569 COPD patients with 2.5-8 years of follow-up in secondary care, to evaluate potential determinants and the prognostic significance
Inhaled long acting Beta-2 (?2) agonists for COPD Inhaled long acting ß2 agonists for COPD November - December 2017 Mailing Address: Therapeutics Initiative The University of British Columbia Department of Anesthesiology, Pharmacology & Therapeutics 2176 Health Sciences Mall Vancouver, BC Canada V6T 1Z3 Tel.: 604 822 0700 Fax: 604 822 0701 E-mail: email@example.com www.ti.ubc.ca 109 I n Therapeutics Letter #102 1 we reviewed the inhaled long acting ß2 agonist (LABA) indacaterol for chronic obstruc (...) - tive pulmonary disease (COPD). We concluded “There are no proven clinically meaningful benefits in terms of reduc- tion in mortality or total serious adverse events…” for this indication based on 12 trials in 6,947 patients. In this Letter we report systematic reviews of 3 other inhaled LABA drugs licensed for COPD: formoterol, arformoterol and salmeterol. Objective To determine the clinical efficacy of inhaled formoterol, arformoterol and salmeterol as compared to placebo for chronic maintenance
Core IM: Mind the Gap on COPD Classifications Core IM: Mind the Gap on COPD Classifications – Clinical Correlations Search Core IM: Mind the Gap on COPD Classifications February 14, 2018 3 min read 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
Fluticasone furoate / umeclidinium / vilanterol (Trelegy Ellipta) - maintenance treatment in adult patients with moderate to severe chronic obstructive pulmonary disease (COPD) Published 12 February 2018 Product Update fluticasone furoate, umeclidinium, vilanterol (as trifenatate) 92 micrograms / 55 micrograms / 22 micrograms inhalation powder (Trelegy ® Ellipta ® ) SMC No 1303/18 GlaxoSmithKline UK 12 January 2018 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 submission fluticasone furoate / umeclidinium / vilanterol (as trifenatate) (Trelegy ® Ellipta ® ) is accepted for restricted use within NHS Scotland. Indication under review: maintenance treatment in adult patients with moderate to severe chronic obstructive pulmonary disease (COPD) who are not adequately treated
Effects of umeclidinium/vilanterol on exercise endurance in COPD: a randomised study This multicentre, randomised, double-blind, placebo-controlled, two-period crossover study assessed the effect 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 1 s (FEV1) and 3-h post-dose functional residual capacity (FRC), both at week 12. COPD Assessment Test (CAT) score at week 12 was also assessed. UMEC/VI treatment did not result in a statistically significant improvement in EET change from baseline at week 12 versus placebo (p=0.790
Effect of erdosteine on the rate and duration of COPD exacerbations: the RESTORE study 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-to-treat population of 445 patients (74% male; mean age 64.8 years, forced expiratory volume in 1 s 51.8% predicted) erdosteine reduced the exacerbation rate by 19.4% (0.91 versus 1.13 exacerbations·patient
Baseline Symptom Score Impact on Benefits of Glycopyrrolate/Formoterol Metered Dose Inhaler in COPD 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, health status, rescue medication use, and exacerbation risk.In 3,699 patients, improvement in FEV1 at week 24 between the GFF MDI and monocomponent MDIs and a placebo MDI was similar in magnitude regardless of baseline CAT score
A simple algorithm for the identification of clinical COPD phenotypes 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 (especially regarding severity of respiratory disease and the presence of cardiovascular comorbidities and diabetes). The CART-based algorithm indicated that the variables relevant for patient
COPDCOPD - Symptoms, diagnosis and treatment | BMJ Best Practice Search COPD Last reviewed: February 2019 Last updated: November 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 pulmonary function tests, chest x-ray, chest computed tomography scan, oximetry, and arterial blood gas 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
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: February 2019 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
Singing for adults with chronic obstructive pulmonary disease (COPD). Singing is a complex physical activity dependent on the use of the lungs for air supply to regulate airflow and create large lung volumes. In singing, exhalation is active and requires active diaphragm contraction and good posture. Chronic obstructive pulmonary disease (COPD) is a progressive, chronic lung disease characterised by airflow obstruction. Singing is an activity with potential to improve health outcomes in people (...) with COPD.To determine the effect of singing on health-related quality of life and dyspnoea in people with COPD.We identified trials from the Cochrane Airways Specialised Register, ClinicalTrials.gov, the World Health Organization trials portal and PEDro, from their inception to August 2017. We also reviewed reference lists of all primary studies and review articles for additional references.We included randomised controlled trials in people with stable COPD, in which structured supervised singing training
Natural history of COPD: gaps and opportunities 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 opportunities for research, in this field. In particular, it discusses the following six specific questions. 1) Is COPD (...) a "single" disease? 2) Is COPD "only" a lung disease? 3) When does COPD begin or what is "early" COPD? 4) How does COPD "progress"? 5) How do we assess disease "severity"? 6) Can COPD be prevented (beyond smoking cessation) or its course be modified once detected?
The effectiveness of a nurse-led illness perception intervention in COPD patients: a cluster randomised trial in primary care 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 the effectiveness of the intervention in primary care. A cluster randomised controlled trial was conducted within 30 general practices and five home-care centres, including 204 COPD patients. 103 patients were randomly assigned to the intervention group and 101 patients to the usual-care group. To assess differences, repeated multilevel linear mixed modelling analyses were used. Primary outcome was change in health status on the Clinical COPD Questionnaire (CCQ) at 9 months