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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
A qualitative study of patients' experiences of participating in SPACE for COPD: a Self-management Programme of Activity, Coping and Education 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. Interviews took place at 6 weeks and 6 months following the programme. Data were analysed at each time point using inductive thematic analysis, and subsequently re-examined together. 40 interviews were undertaken and four themes emerged from the analysis: perceptions
Long-Acting β-Agonists (LABA) Combined With Long-Acting Muscarinic Antagonists or LABA Combined With Inhaled Corticosteroids for Patients With Stable COPD. 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?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.
Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline | European Respiratory Society Main menu User menu Search Search for this keyword Search for this keyword Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline Jadwiga A. Wedzicha (ERS co-chair) , Marc Miravitlles , John R. Hurst , Peter M.A (...) obstructive pulmonary disease (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 and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts. After considering
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 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 (...) and hospital-based PR remained independent predictors of a lower risk for 1) acute COPD exacerbation (incidence rate ratio (IRR) 0.517, 95% CI 0.389-0.687, and IRR 0.635, 95% CI 0.473-0.853), respectively, and 2) hospitalisations for acute COPD exacerbation (IRR 0.189, 95% CI 0.100-0.358, and IRR 0.375, 95% CI 0.207-0.681), respectively. However, only home-based maintenance tele-rehabilitation and not hospital-based, outpatient, maintenance PR was an independent predictor of ED visits (IRR 0.116, 95% CI
Effects of combined tiotropium/olodaterol on inspiratory capacity and exercise endurance in COPD Two replicate, double-blind, 6-week, incomplete-crossover studies (MORACTO 1 and 2) assessed the effects of tiotropium/olodaterol on inspiratory capacity and exercise endurance time in patients with moderate to severe chronic obstructive pulmonary disease.For each patient, four of five treatments were administered once daily for 6 weeks, with a 21-day washout between treatments: tiotropium
Colistin for Prophylactic Use in Non-Cystic Fibrosis Bronchiectasis or COPD with Exacerbations: A Review of Clinical and Cost-Effectiveness and Guidelines Colistin for Prophylactic Use in Non-Cystic Fibrosis Bronchiectasis or COPD with Exacerbations: A Review of Clinical and Cost-Effectiveness and Guidelines | CADTH.ca Find the information you need Colistin for Prophylactic Use in Non-Cystic Fibrosis Bronchiectasis or COPD with Exacerbations: A Review of Clinical and Cost-Effectiveness (...) and Guidelines Colistin for Prophylactic Use in Non-Cystic Fibrosis Bronchiectasis or COPD with Exacerbations: A Review of Clinical and Cost-Effectiveness and Guidelines Published on: June 27, 2017 Project Number: RC0896-000 Product Line: Research Type: Drug Report Type: Summary with Critical Appraisal Result type: Report Question What is the clinical effectiveness of colistin for the prophylactic treatment of adults with either non-cystic fibrosis bronchiectasis or patients with chronic obstructive
Umeclidinium bromide versus placebo for people with chronic obstructive pulmonary disease (COPD). People with chronic obstructive pulmonary disease (COPD) have poor quality of life, reduced survival, and accelerated decline in lung function, especially associated with acute exacerbations, leading to high healthcare costs. Long-acting bronchodilators are the mainstay of treatment for symptomatic improvement, and umeclidinium is one of the new long-acting muscarinic antagonists approved (...) ) of parallel design comparing umeclidinium bromide versus placebo in people with COPD, for at least 12 weeks.We used standard Cochrane methodological procedures. If we noted significant heterogeneity in the meta-analyses, we subgrouped studies by umeclidinium dose.We included four studies of 12 to 52 weeks' duration, involving 3798 participants with COPD. Mean age of participants ranged from 60.1 to 64.6 years; most were males with baseline mean smoking pack-years of 39.2 to 52.3. They had moderate
Cost-effectiveness of antibiotics for COPD management: observational analysis using CPRD data It is often difficult to determine the cause of chronic obstructive pulmonary disease (COPD) exacerbations, and antibiotics are frequently prescribed. This study conducted an observational cost-effectiveness analysis of prescribing antibiotics for exacerbations of COPD based on routinely collected data from patient electronic health records. A cohort of 45 375 patients aged 40 years or more who (...) attended their general practice for a COPD exacerbation during 2000-2013 was identified from the Clinical Practice Research Datalink. Two groups were formed ("immediate antibiotics" or "no antibiotics") based on whether antibiotics were prescribed during the index general practice (GP) consultation, with data analysed according to subsequent healthcare resource use. A cost-effectiveness analysis was undertaken from the perspective of the UK National Health Service, using a time horizon of 4 weeks
Effect of Home Noninvasive Ventilation With Oxygen Therapy vs Oxygen Therapy Alone on Hospital Readmission or Death After an Acute COPD Exacerbation: A Randomized Clinical Trial. Outcomes after exacerbations of chronic obstructive pulmonary disease (COPD) requiring acute noninvasive ventilation (NIV) are poor and there are few treatments to prevent hospital readmission and death.To investigate the effect of home NIV plus oxygen on time to readmission or death in patients with persistent (...) hypercapnia after an acute COPD exacerbation.A randomized clinical trial of patients with persistent hypercapnia (Paco2 >53 mm Hg) 2 weeks to 4 weeks after resolution of respiratory acidemia, who were recruited from 13 UK centers between 2010 and 2015. Exclusion criteria included obesity (body mass index [BMI] >35), obstructive sleep apnea syndrome, or other causes of respiratory failure. Of 2021 patients screened, 124 were eligible.There were 59 patients randomized to home oxygen alone (median oxygen
A qualitative study of women's experiences of living with COPD To explore women's experiences of living with chronic obstructive pulmonary disease (COPD) at home.An explorative and descriptive qualitative design.A consecutive sample of nine women with COPD living at home. Data were collected in 2014 using semi-structured interviews and analysed using a qualitative content analysis.Three main themes were identified: having a good life with COPD despite limitations; predictability and confidence (...) in getting help; and the struggle to achieve a balance between insight and compliance with management of COPD. These women experienced limitations related to the traditional female role and felt unable to fulfil their own expectations. They experienced a good life despite limitations arising from adaptation and coping strategies. To feel safe, they needed to feel confident that they would receive the necessary help in case of exacerbation of their disease. To enhance compliance with COPD management
CRACKCast E074 – COPD CRACKCast E074 - COPD - CanadiEM CRACKCast E074 – COPD In , by Adam Thomas May 1, 2017 This episode of CRACKCast covers Rosen’s Chapter 74, COPD. This airway disease process is one of the most common causes of death worldwide. Approximately 20% of all hospital admissions for patients over age 65 are related to COPD, and so an approach to management will have nearly daily benefit for an emergency physician. Shownotes – Rosens in Perspective Pathophysiology of COPD According (...) to Global Initiative for Chronic Obstructive Lung Disease (GOLD), COPD is: “a preventable and treatable disease with some significant extra-pulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible… the airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases.” This used to include elements of reversible airflow
Cardiovascular outcomes with an inhaled beta2-agonist/corticosteroid in patients with COPD at high cardiovascular risk Cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) often coexist. We assessed the effect of inhaled COPD treatments on CVD outcomes and safety in patients with COPD and at heightened CVD risk.The SUMMIT (Study to Understand Mortality and MorbidITy) was a multicentre, randomised, double-blind, placebo-controlled, event-driven trial in 16 485 patients (...) with moderate COPD who had or were at high risk of CVD. Here, we assessed the prespecified secondary endpoint of time to first on-treatment composite CVD event (CVD death, myocardial infarction, stroke, unstable angina or transient ischaemic attack (TIA)) by Cox regression and by clinician-reported CVD adverse events across the four groups: once-daily inhaled placebo (n=4111), long-acting beta2-agonist (vilanterol (VI) 25 µg; n=4118), corticosteroid (fluticasone furoate (FF) 100 µg; n=4135) and combination
Palliative and end-of-life care conversations in COPD: a systematic literature review Chronic obstructive pulmonary disease (COPD) is a chronic life-limiting disorder characterised by persistent airflow obstruction and progressive breathlessness. Discussions/conversations between patients and clinicians ensure palliative care plans are grounded in patients' preferences. This systematic review aimed to explore what is known about palliative care conversations between clinicians and COPD patients (...) conversations is generally poor. Patients and physicians identified many barriers and important topics were not discussed. Patients and clinicians reported tension between remaining hopeful and the reality of the patients' condition. When discussions did happen, they often occurred at an advanced stage of illness and in respiratory wards and intensive care units. In conclusion, current care practices do not facilitate satisfactory conversations about palliative care between COPD patients and clinicians
Procalcitonin and CRP as Biomarkers in Discrimination of Community-acquired Pneumonia and Exacerbation of COPD Serum procalcitonin (PCT) and C-reactive protein (CRP) are markers of systemic inflammation and bacterial infection. We aimed to compare the usefulness of procalcitonin and CRP in patients with community-acquired pneumonia and exacerbations of chronic obstructive pulmonary disease (COPD).A total of 116 consecutive patients were included in the study: 76 with chronic obstructive (...) pulmonary disease in group 1, and 40 with pneumonia in group 2.Median serum CRP level was 44 mg/L in the COPD group and 132 mg/L in the pneumonia group. Median value of serum PCT was found to be 0.07 in the COPD group and 0.14 ng/mL in the pneumonia group. Serum PCT and CRP levels were significantly higher in the pneumonia group compared to the COPD group (p<0.001). The area under the ROC curve was 0.788 (CI: 0.704-0.872) for CRP and 0.699 (CI: 0.599-0.800) for procalcitonin to identify