Acute Chronic Obstructive Pulmonary Disease Research Articles

Management of acute severe asthma and chronic obstructive pulmonary disease.

Management of acute severe asthma and chronic obstructive pulmonary disease.

Atrial electromechanical delay, neutrophil-to-lymphocyte ratio, and echocardiographic changes in patients with acute and stable chronic obstructive pulmonary disease.

Atrial electromechanical delay (AEMD) is the time interval between the beginning of P wave on surface electrocardiography and starting of the late diastolic wave on tissue Doppler imaging. We investigated the prolongation of AEMD, echocardiographic changes, and correlation of these findings with neutrophil-to-lymphocyte ratio (NLR) in patients with chronic obstructive pulmonary disease (COPD). The study consisted of 105 (49 females and 56 males; mean age: 65.1 ± 9) patients with COPD exacerbation and 104 (21 females and 83 males; mean age: 64.8 ± 9.6) stable COPD outpatients. Demographics, body mass index, pulmonary function tests, and transthoracic echocardiography of the patients were evaluated. Echocardiography was performed in the first 6 h for stable COPD outpatients and in the first 24 h for COPD exacerbation patients. Diameters of right ventricle (RV), left ventricle (LV) and left atrium, aortic root diameters, left ventricular ejection fraction (LVEF), Emax, Amax, Emax/Amax, tricuspid annular plane systolic excursion (TAPSE), Ea, Aa, Ea/Aa, Emax/Ea, and tricuspid regurgitation velocity (TRV) were evaluated. AEMD measurements were obtained from lateral/tricuspid, lateral/mitral, and septal annulus from apical four-chamber views with tissue Doppler imaging and corrected for heart rate. Complete blood count including NLR was also assessed. The mean age of patients in exacerbation period (65.1 ± 9) was higher than the stable group (64.8 ± 9.6). RV basal and mid diameters (P < 0.001), Amax (P < 0.001), Ea tricuspid (P = 0.040), Aa tricuspid (P < 0.001), TRV, and systolic pulmonary artery pressure (P < 0.001) were higher; TAPSE and tricuspid Emax/Amax (P < 0.001) were significantly lower in patients with COPD exacerbation. LV end-diastolic diameter (P = 0.002) and LVEF (P = 0.005), Emax/Amax mitral (P < 0.001), Ea/Aa mitral (P < 0.001), and Ea/Aa septal (P < 0.001) were significantly lower; Amax mitral (P = 0.002), Aa mitral (P < 0.001), Aa septal (P < 0.001), and systolic motion mitral (P = 0.011) were significantly higher in patients with exacerbation. AEMD lateral/tricuspid (P < 0.001), lateral/mitral (P < 0.001), and septal (P < 0.001) were significantly higher in patients with COPD exacerbation. Neutrophil and lymphocyte count (P < 0.001) and NLR (P = 0.003) were significantly higher in the acute group. A weak correlation of NLR with LV end-diastolic diameter (P = 0.003; r = 0.357), Emax/Ea mitral (P = 0.019; r = 0.285), Emax tricuspid (P = 0.045; r = -0.244), and systolic motion septal (P = 0.003; r = 0.352) was detected in patients with stable COPD. In COPD exacerbation patients, prolongation of AEMD intervals was determined. Acute period of COPD may trigger atrial dysrhythmias including atrial fibrillation and flutter, multifocal atrial tachycardia, premature beats, and both systolic and diastolic dysfunctions frequently.

Sonographic examination of respiratory muscles in chronic obstructive lung disease and evaluation of the relationship with clinical severity of exacerbation

Aim: This study aimed to sonographically examine the fraction of thickening in the respiratory muscles during the acute exacerbation of chronic obstructive pulmonary disease (COPD) and to determine its relationship with the clinical severity of the exacerbation.Methods: This prospective study looked at 159 people over the age of 50 who were diagnosed with COPD using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria and were admitted to the hospital because they were having an acute COPD flare-up. Ultrasonography was used to measure how thick the parasternal intercostals, pectoralis major, and diaphragm muscles were in each patient.Results: Of the patients, 63 had mild, 63 had moderate, and 33 had severe exacerbations. Parasternal intercostal and pectoralis major muscle thickening fractions were significantly higher in moderate and severe exacerbations compared to mild exacerbations, while the diaphragm muscle thickening fraction was significantly lower (p

Investigation of an Unusual Crow Mortality Event in Jessore, Bangladesh, December 2018

After a report of an unusually high number of crow deaths in Jessore, Bangladesh, a multidisciplinary team investigated the event in December 2018 to identify the etiologic agent, and the source and extent of the outbreak. We interviewed students, teachers, live bird sellers, poultry farm owners and cleaners for fever and cough symptoms. We reviewed the hospital records for acute respiratory distress syndrome and chronic obstructive pulmonary disease. We observed live bird market practices, crow roosts and their feeding behavior, and collected cloacal and oropharyngeal swabs from moribund and dead crows, and pooled environmental samples from live bird markets (LBMs) and farms. All samples were tested for influenza A/H5, H7 and H9 by RT-PCR. The H5 prevalence was 77.4% in samples obtained from crow roosts. Among environmental samples from the LBMs, 11.1% were positive for H5 and 5.5% had co-infections with H5 and H9. Our results indicate that the H5 influenza virus is circulating in LBMs and was transmitted to crows through their feeding on the waste. We recommend that continuous surveillance in wild birds and LBMs is required to understand the virus’s evolution, transmission pathways and potential source of infection. Improved waste management practices in LBMs and public awareness are needed to reduce the risk and stop spillover of avian influenza virus to humans in Bangladesh.

Prevalence of Obstructive Sleep Anpea among Chronic Obstructive Pulmonary Disease Patients

Background and Aim: Chronic obstructive pulmonary disease (COPD) is related to a number of comorbidities that contribute to various phenotypes, including increased mortality rates and decreased physical activity. The present study aim was to determine the incidence of obstructive sleep apnea among chronic obstructive pulmonary disease patients. Methodology: This prospective study was carried out on 250 obstructive pulmonary disease patients at the department of Medicine/ Pulmonology, Fauji Foundation Hospital, Rawalpindi and Avicenna hospital, Lahore from February 2021 to July 2021. Out of 250 patients, 128 patients were enrolled based on clinical examination, medical history and pulmonary tests. Ethical approval was taken from the respective institutional ethical committees. Written informed consent was taken from all the patients. All the patients with sputum production, history of disease exposure and risk factors, chronic cough and forced vital capacity with volume of post-bronchodilator forced expiratory presence in first capacity &lt;70% were enrolled. Patients with thyroid dysfunction, decompensated heart failure, hepatic and renal impaired, Obstructive sleep apnea (OSA) caused by ENT, and acute COPD patients (forced vital capacity &lt;30% or &lt;50% anticipated were excluded. Based on BMI, COPD patients were categorized into two groups: Group-I had 64 obese patients of chronic obstructive pulmonary disease (BMI≥ 29 kg/m2) and non-obese COPD patients (BMI≤ 29 kg/m2) in Group-II. SPSS version 21 was used for data analysis. Results: Of the total 128 COPD patients, male and female patients were 84 (65.6%) and 44 (34.4%) respectively. Out of 128 COPD patients, the incidence of mild, moderate, and severe COPD was 28 (21.9%), 68 (53.1%), and 32 (25%) respectively. The severity of obstructive sleep apnea was 9 (32.1%) in mild, 28 (41.2%) in moderate, and 27 (84.4%) in severe respectively. Based on body mass index (kg/m2), incidence of mild, moderate and severe cases in Group-I (Obese) and Group-II (non-obese) were 3 (2.3%), 20 (15.6%), and 41 (64.1%) and 26 (20.3%), 33 (25.8%), and 5 (3.9%) respectively. Conclusion: Our study found that sleep-disordered breathing diagnosed in moderate and severe in COPD patients. Obstructive sleep apnea are more likely to develop in Obese COPD patients. Keywords: Obstructive sleep apnea, COPD, Obesity

Nebulized Magnesium Sulphate vs Normal Saline as an Adjunct in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Magnesium revealed to have properties of bronchodilation in chronic obstructive pulmonary disease (COPD) and asthma. A clinical benefit of nebulization with magnesium has been observed in asthma. The aim of the analysis was the therapeutic benefits comparison of using magnesium sulphate in nebulized form as an adjuvant of the normal saline solution among patients with exacerbations of COPD. Study Design: A randomized single blind interventional study. Place and Duration: In the Department of Medicine, Islam Medical College and Teaching Hospital Sialkot for six months duration from March 2021 to September 2021 Methods: This study involved 132 cases of acute COPD exacerbations with PEFR &lt;300 L / min, evaluated twenty mints after initial therapy. Patients were administered salbutamol 5mg mixed with 3 ml of saline or 3 ml of isotonic magnesium sulphate three times at thirty-minute intervals using a nebulizer. At 90 minutes: Primary outcome of PEFR were measured and admission to hospital, invasive or non-invasive ventilation along with mortality were measured as 2ndry outcomes. Results: After nebulization with magnesium sulphate, the mean PEFR was 86.3 ± 11.9 l / min, 97.6 ± 19.1 l / min and 99.6 ± 15.2 l / min and 79.17 ± 14.11 l / min, 90.17 ± 18.27 l / min, and 93.17. ± 20.63 L. Statistically significant differences were found in the normal saline group at thirty, sixty and ninety minutes, correspondingly. In the magnesium group, 91.9% were admitted to the ward, 8.1% to the intensive care unit, 81.7% to the ward, and 18.3% to the salt group to the intensive care unit. The differences in ventilation and mortality were negligible. Conclusions: In the context of AECOPD, nebulized magnesium sulphate in combination with salbutamol has a therapeutic advantage over PEFR, but has no effect on hospitalization, the need for mortality and non-invasive or invasive ventilation. Keywords: Peak expiratory flow, magnesium sulphate and chronic obstructive pulmonary disease.

Prediction of Acute COPD Exacerbation in the Swiss Multicenter COPD Cohort Study (TOPDOCS) by Clinical Parameters, Medication Use, and Immunological Biomarkers

Background and Objective: Whether immunological biomarkers combined with clinical characteristics measured during an exacerbation-free period are predictive of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) frequency and severity is unknown. Method: We measured immunological biomarkers and clinical characteristics in 271 stable chronic obstructive pulmonary disease (COPD) patients (67% male, mean age 63 years) from “The Obstructive Pulmonary Disease Outcomes Cohort of Switzerland” cohort on a single occasion. One-year follow-up data were available for 178 patients. Variables independently associated with AECOPD frequency and severity were identified by multivariable regression analyses. Receiver operating characteristic analysis was used to obtain optimal cutoff levels and measure the area under the curve (AUC) in order to assess if baseline data can be used to predict future AECOPD. Results: Higher number of COPD medications (adjusted incident rate ratio [aIRR] 1.17) and platelet count (aIRR 1.03), and lower FEV₁% predicted (aIRR 0.84) and IgG2 (aIRR 0.84) were independently associated with AECOPD frequency in the year before baseline. Optimal cutoff levels for experiencing frequent (>1) AECOPD were ≥3 COPD medications (AUC = 0.72), FEV₁ ≤40% predicted (AUC = 0.72), and IgG2 ≤2.6 g/L (AUC = 0.64). The performance of a model using clinical and biomarker parameters to predict future, frequent AECOPD events in the same patients was fair (AUC = 0.78) but not superior to a model using only clinical parameters (AUC = 0.79). The IFN-lambda rs8099917GG-genotype was more prevalent in patients who had severe AECOPD. Conclusions: Clinical and biomarker parameters assessed at a single point in time correlated with the frequency of AECOPD events during the year before and the year after assessment. However, only clinical parameters had fair discriminatory power in identifying patients likely to experience frequent AECOPD.

Application Value of Blood Heparin-Binding Protein in the Diagnosis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Objective To investigate the expression and clinical significance of serum heparin-binding protein (HBP), C-reactive protein (CRP), and white blood cell count (WBC) in an acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods A prospective research model was used to select 63 patients with acute exacerbation of chronic obstructive pulmonary disease who were hospitalized in Xuzhou First People's Hospital from January 2020 to June 2020, and among the chronic obstructive pulmonary disease patients who were followed up in our hospital during the same period, 18 patients were in the stable phase, and 43 healthy patients in our hospital during the same period were selected as the healthy control group. 18 patients with stable chronic obstructive pulmonary disease were selected as the observation group, and 43 healthy people who underwent examination at the same time as the control group. For patients with acute COPD recombination, 5 ml of venous blood was collected according to whether the condition of COPD patients with acute exacerbation was stable or not. 5 ml of venous blood was collected for acute exacerbation. According to their clinical symptoms (such as cough, sputum, and asthma), dyspnea score (MRC score), and pulmonary function (FEV1 and FEV1/FVC), it is determined whether the patient's condition is stable. Patients in the stable COPD group will collect 5 ml of venous blood during the outpatient follow-up, and those in the healthy physical examination group will collect veins on the day of the physical examination. In 5 ml of blood, the levels of HBP and CRP in the blood were measured by the enzyme-linked immunosorbent method and the immunoturbidimetric method, respectively, and the peripheral blood WBC was measured by a blood cell analyzer and its supporting reagents. The differences of the three indicators in each group were statistically analyzed. Normally distributed measurement data were compared using t-test, homogeneity of variance of nonnormally distributed measurement data were compared using one-way analysis of variance, uneven variance of nonnormally distributed measurement data were compared using a rank-sum test, and Pearson linear analysis was used for correlation test. Subject working characteristic curve (ROC) was drawn, P < 0.05 means the difference is statistically significant, the receiver working characteristic curve was established, and the area under the curve (AUC) was calculated to analyze blood HBP. The value of blood CRP and peripheral blood WBC counts alone or in combination in the diagnosis of acute exacerbations of chronic obstructive pulmonary disease. Results The level of blood heparin-binding protein in the acute exacerbation phase was significantly higher than that in the stable phase and healthy controls (P < 0.05). In the acute exacerbation stage and stable stage group, the blood heparin binding protein, the percentage of leukocytes, neutrophils, and CRP were detected. There is a correlation between (P < 0.05) and a correlation with lung function (FEV1) (P < 0.05). The predictive value of heparin-binding protein, white blood cells, neutrophil percentage, CRP, etc. for the acute exacerbation of chronic obstructive pulmonary disease, with the area under the heparin-binding protein curve, is the largest, and compared with the stable phase, the comparison of heparin-binding protein, white blood cells, and CRP is statistically significant (P < 0.05). Conclusion Heparin-binding protein increases in the stable phase and acute exacerbation phase and is related to other inflammatory factors. It is one of the important inflammatory factors in chronic obstructive pulmonary disease. Heparin-binding protein, white blood cells, CRP, etc. have diagnostic and predictive value for acute exacerbation of chronic obstructive pulmonary disease. Heparin-binding protein has the best predictive result, and the combined index test has a better diagnostic predictive value, which is better than single index detection.

Circulating JNK pathway-associated phosphatase: A novel biomarker correlates with Th17 cells, acute exacerbation risk, and severity in chronic obstructive pulmonary disease patients.

BackgroundJNK pathway‐associated phosphatase (JKAP) involves in the regulation of inflammation, immunity, and lung injury. The current study aimed to investigate correlation of JKAP with Th1, Th17 cells, acute exacerbation risk, and disease severity in chronic obstructive pulmonary disease (COPD) patients.MethodsTotally, 45 stable COPD (SCOPD) patients, 45 acute exacerbation COPD (AECOPD) patients, and 45 controls were enrolled. Serum was collected for JKAP, interferon‐gamma (IFN‐γ) (Th1 cytokine), and interleukin 17 (IL‐17) (Th17 cytokine) detection. Besides, peripheral blood mononuclear cell from COPD patients was collected for evaluating Th1 and Th17 cells.ResultsJKAP was highest in controls followed by SCOPD patients and lowest in AECOPD patients (median: 105.673 vs. 75.374 vs. 41.807 pg/ml, p < 0.001). Meanwhile, receiver operating characteristic (ROC) curves revealed that JKAP differentiated the AECOPD patients from the controls (area under curve (AUC): 0.910 (95% confidence interval (CI): 0.849–0.970)) and AECOPD patients from SCOPD patients (AUC: 0.726 (95% CI: 0.622–0.830)). Moreover, JKAP positively correlated with FEV1 (%predicted) in AECOPD patients (r = 0.347 p = 0.019). Additionally, JKAP was negatively correlated with the GOLD stage in AECOPD patients (r = −0.344, p = 0.021) and SCOPD patients (r = −0.357, p = 0.016). Whereas, JKAP was not associated with other clinical features (all p > 0.05). Besides, JKAP was negatively linked with Th17 cells (r = −0.378, p = 0.010), IFN‐γ (r = −0.358, p = 0.016), IL‐17 (r = −0.414, p = 0.005) in AECOPD patients and Th17 cells (r = −0.342, p = 0.022), IL‐17 (r = −0.299, p = 0.046) in SCOPD patients.ConclusionDownregulated JKAP correlates with Th17 cells, higher acute exacerbation risk, and severity in COPD patients, indicating its underlying potency as a biomarker for COPD.

Ninety Day Post Discharge Outcome in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Using the PEARL Score.

Chronic obstructive pulmonary disease exacerbation is a leading cause of frequent hospitalizations imposing substantial global health burden. The 90 day post discharge period has been associated with higher readmission rates and substantial risk of death. The aim of this study was to assess post discharge 90 day outcome in patients admitted with acute Chronic obstructive pulmonary disease exacerbation using the PEARL score. A longitudinal study was conducted at Tribhuvan University Teaching hospital from February 2019 to November 2019. Patients admitted in respiratory ward with acute Chronic obstructive pulmonary disease exacerbation were stratified into low, intermediate and high risk groups using PEARL score and post discharge 90 day outcome was assessed. Data entry and analysis was done in SPSS version 20.0. Descriptive and inferential statistics were performed. A total of 102 patients were included for final analysis. Mean age of patients was 70.54 ± 10.85 years. There were 53.9% male. Intermediate and high risk PEARL groups had the highest proportion of readmission within 90 days of discharge which was found to be 23 (52.3%) and 9 (50%) respectively. High risk PEARL group had the highest proportion of death within 90 days (11.1%). The difference in these outcomes among three PEARL groups was found to be statistically significant (p-value < 0.05). PEARL score is a simple tool that can be applied at bedside in assessing 90 dayrisk of readmission or death in acute Chronic obstructive pulmonary disease exacerbation. This can be beneficial in post-discharge planning and early referral especially in resource limited health care setting where advanced facilities are not available.

Developmental endothelial locus-1 as a potential biomarker for the incidence of acute exacerbation in patients with chronic obstructive pulmonary disease

BackgroundDespite the high disease burden of chronic obstructive pulmonary disease (COPD) and risk of acute COPD exacerbation, few COPD biomarkers are available. As developmental endothelial locus-1 (DEL-1) has been proposed to possess beneficial effects, including anti-inflammatory effects, we hypothesized that DEL-1 could be a blood biomarker for COPD.ObjectiveTo elucidate the role of plasma DEL-1 as a biomarker of COPD in terms of pathogenesis and for predicting acute exacerbation.MethodsCigarette smoke extract (CSE) or saline was intratracheally administered to wild-type (WT) and DEL-1 knockout (KO) C57BL/6 mice. Subsequently, lung sections were obtained to quantify the degree of emphysema using the mean linear intercept (MLI). Additionally, plasma DEL-1 levels were compared between COPD and non-COPD participants recruited in ongoing prospective cohorts. Using negative binomial regression analysis, the association between the plasma DEL-1 level and subsequent acute exacerbation risk was evaluated in patients with COPD.ResultsIn the in vivo study, DEL-1 KO induced emphysema (KO saline vs. WT saline; P = 0.003) and augmented CSE-induced emphysema (KO CSE vs. WT CSE; P < 0.001) in 29 mice. Among 537 participants, patients with COPD presented plasma log (DEL-1) levels lower than non-COPD participants (P = 0.04), especially non-COPD never smokers (P = 0.019). During 1.2 ± 0.3 years, patients with COPD in the lowest quartile of Log(DEL-1) demonstrated an increased risk of subsequent acute exacerbation, compared with those in the highest quartile of Log(DEL-1) (adjusted incidence rate ratio, 3.64; 95% confidence interval, 1.03–12.9).ConclusionLow DEL-1 levels are associated with COPD development and increased risk of subsequent COPD acute exacerbation. DEL-1 can be a useful biomarker in patients with COPD.

Pricing air pollution: evidence from short-term exposure to air pollution on hospitalization of acute bronchitis and chronic obstructive pulmonary disease in southwestern China.

Existing evidence suggests that ambient air pollution has serious adverse effects on respiratory diseases, yet there is little direct evidence from China regarding corresponding economic losses. Here we quantified air pollution-related acute health effects and related economic losses of the most common two respiratory diseases in southwestern China, acute bronchitis and chronic obstructive pulmonary disease (COPD). We applied a distributed lag non-linear model to analyse the relationship between ambient air pollutants and hospital admissions of acute bronchitis and COPD, then applied the cost of illness method to explore the attributing economic burden. During the study period, 528 334 and 99 419 hospital admissions of acute bronchitis and COPD, respectively, were recorded. As a result, during the study period the total hospitalization economic losses attributable to air pollution were 486.40 and 254.74 million yuan for acute bronchitis and COPD, respectively, accounting for 0.015% of local gross domestic product. Our research provides intuitive evidence on the health and economic impacts of short-term exposure to air pollution, which is a key basis for the formulation of environmental policies.

Evaluating the Benefits of Viral Respiratory Panel Test in the Reduction of Emergency Department Throughput Time for Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

IntroductionThere has been a widespread antibiotic prescription in the Emergency Department (ED) among patients presenting with acute exacerbation chronic obstructive pulmonary disease (AECOPD) irrespective of the causative agent of the disease. The viral respiratory panel (VRP) test is designed to detect viral pathogens in the respiratory tract, which may contribute to the exacerbation of chronic obstructive pulmonary disease (COPD), as the upper and lower respiratory tract infections are caused by a broad range of microbes and not only bacteria. The aim of this study is to weigh the benefits of obtaining a VRP in patients presenting with isolated symptoms pertaining to well-defined criteria of an AECOPD with preexisting COPD or reactive airway disease to find out how such test impacts patient throughput time in the ED and also investigate how obtaining a VRP affects the use of antibiotics in this patient population. It is important that ED physicians accurately diagnose the main cause of AECOPD to help optimize the use of health care resources, including antibiotics, antivirals, inpatient, and ED beds. VRP testing must be taken into consideration as it helps eliminate the need of administering antibiotics to every patient who presents to the ED with AECOPD.Design and methodThis is a case-control observational study using retrospective chart review to obtain patients’ data from our hospital data warehouse. Data on patients with the primary diagnosis of AECOPD in the past two years were retrieved. A comparison between those who had VRP on arrival in the ED and those who did not have a VRP obtained was performed. We also compared ED throughput time for patients with AECOPD who received antibiotics to those who did not receive antibiotics. Only patients between the ages of 18 and 64 were included in the study. Patients with other preexisting health conditions such as cardiac diseases, neurological problems, and abdominal complaints were excluded. Patients who required hospitalization and pregnant patients were excluded from the study.ResultsWe collected the data of 340 patients who met the study criteria. Of the 340 patients enrolled, 65 (19%) received the VRP test and 275 (81%) did not receive VRP test. Among the 65 patients who received the VRP test, 45 (70%) had a virus etiology detected and reported in the ED (p=0.001). Also, 138 (50.2%) did not receive VRP test and were not given antibiotics, and 137 (49.8%) did not receive VRP test but were treated with antibiotics; 11 patients received antibiotics despite haven tested positive to a virus. The result showed that those who received antibiotics with no VRP test on arrival in the ED had a shorter throughput time compared to patients who did not receive antibiotics but received VRP test.ConclusionThe study is a quality improvement study to help determine the efficacy and appropriateness of ordering a VRP prior to ED disposition and the impact of overall ED throughput time for each patient presenting with AECOPD. The study showed that antibiotics did play a significant role in the duration of the throughput time in patients with AECOPD. However, rapid VRP testing was indeed associated with a trend toward decreased antibiotic use in the ED.

AND-ASPEN and ESPEN consensus, and GLIM criteria for malnutrition identification in AECOPD patients: a longitudinal study comparing concurrent and predictive validity.

Malnutrition in chronic obstructive pulmonary disease (COPD) patients is prevalent and usually assessed by body mass index (BMI), which can lead to misdiagnosis. The subjective global assessment (SGA) is the reference method for this diagnose in hospitalized patients. In the last decade, new tools have emerged Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition [AND-ASPEN], European Society for Clinical Nutrition and Metabolism [ESPEN], and Global Leadership Initiative on Malnutrition [GLIM]). Therefore, this study aimed to assess the concurrent and predictive validity of these tools in acute exacerbated COPD (AECOPD) patients. Prospective cohort study with hospitalized AECOPD patients. Malnutrition was diagnosed by SGA (reference method), AND-ASPEN, ESPEN, and GLIM consensus. Hospital length of stay (LOS) and mortality were the outcomes evaluated. In 241 patients (46.5% males; 68.3 ± 10.2 years), malnutrition was found in 50.0% by SGA, 54.4% by AND-ASPEN, 20.2% by ESPEN, and 47.8% by GLIM. AND-ASPEN had the best accuracy (AUC = 0.837; 95% CI 0.783-0.841) and concordance (kappa = 0.674) with SGA and it was an independent predictor of prolonged LOS (OR = 1.73; 95% CI 1.01-3.37). ESPEN consensus did not agree with SGA, but was associated with prolonged LOS (OR = 2.57 95% CI, 1.27-5.20). The GLIM had good concordance (kappa = 0.533) and accuracy with SGA (AUC = 0.768; 95% CI 0.701-0.835), but was not associated with outcomes. The AND-ASPEN was the most accurate tool for diagnosing malnutrition in AECOPD patients and was an independent predictor of prolonged LOS.

Role of locum GPs in antibiotic prescribing and stewardship: a mixed-methods study.

BackgroundMost antibiotics are prescribed in primary care. Locum or sessional GPs (locums) are perceived as contributing to higher prescribing and may face barriers to engaging with antimicrobial stewardship (AMS).AimTo identify how locums’ antibiotic prescribing compares with other general practice prescribers, and how they perceive their role in antibiotic prescribing and AMS.Design and settingMixed-methods study in primary care.MethodData on antibiotic prescribing, diagnoses, and patient and prescriber characteristics were extracted from The Health Improvement Network database. A mixed-effects logistic model was used to compare locums’ and other prescribers’ antibiotic prescribing for conditions that do not usually benefit from antibiotics. Nineteen semi-structured telephone interviews were conducted with locums in England and analysed thematically.ResultsLocums accounted for 11% of consultations analysed. They prescribed antibiotics more often than other GPs and nurse prescribers for acute cough, sore throat, asthma and chronic obstructive pulmonary disease exacerbations, and acute bronchitis. The number of patients receiving antibiotics for these conditions was 4% higher (on absolute scale) when consulting with locums compared with when they consulted with other GPs. Four themes capture the perceived influences on prescribing antibiotics and AMS: antibiotic prescribing as a complex but individual issue, nature and patterns of locum work, relationships between practices and locums, and professional isolation.ConclusionLocums contribute to higher antibiotic prescribing compared with their peers. They experience challenges but also opportunities for contributing to AMS, which should be better addressed. With an increasing proportion of locums in general practice, they have an important role in antibiotic optimisation and AMS.

Is bilevel PAP more effective than CPAP in treating hypercapnic obese patients with COPD and severe OSA?

Commentary on Zheng Y, Yee BJ, Wong K, Grunstein R, Piper A. A pilot randomized trial comparing CPAP versus bilevel PAP spontaneous mode in the treatment of hypoventilation disorder in patients with obesity and obstructive airway disease. J Clin Sleep Med. 20XX;XX(XX):XXX-XXX. doi:10.5664/jcsm.9506.

ANNUAL EXPENDITURES AMONG PATIENTS WITH COPD INITIATING TIOTROPIUM/OLODATEROL VS TRIPLE THERAPY

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: In 2018, 16.4 million U.S. adults reported a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) with annual healthcare costs projected to reach $49 billion by 2020. Up to 70% of COPD-related healthcare expenditures are attributable to acute COPD exacerbations. The 2018 Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends long-acting muscarinic antagonists/beta2-agonists (LAMA+LABA) as next-in-line therapy for symptomatic COPD patients on mono-maintenance therapy. The addition of inhaled corticosteroids and escalation to Triple Therapy [TT] should be reserved for those experiencing further exacerbations and after risk/benefit (e.g., pneumonia) assessment. However, evidence reveals TT is over-prescribed in discordance with GOLD recommendations. The purpose of this study is to compare COPD-related plan paid costs among matched cohorts of TIO+OLO (a fixed-dose LAMA+LABA inhaler) vs. TT initiators in a U.S. Medicare Advantage population: a) naïve to maintenance treatment and b) stratified by baseline exacerbation history (proxy for COPD severity): no=0 exacerbation; single=1 moderate exacerbation; multiple/severe=≥2 moderate or ≥1 severe exacerbation(s). METHODS: This retrospective, observational post-hoc analysis included COPD patients aged ≥40 years initiating TIO+OLO or TT from 01 Jan 2014 to 31 Mar 2018 (treatment initiation date = index date). 12 months pre-index and ≥30 days post-index continuous medical/pharmacy coverage was required. Cohorts were propensity score matched 1:1. Multivariable analyses were used to estimate adjusted annualized post-index mean costs after matching. RESULTS: Among patients naïve to maintenance treatment, TIO+OLO patients had lower mean COPD-related total ($9,422 vs. $16,753; p<0.001), medical ($5,845 vs. 10,009; p<0.001) and pharmacy ($3,669 vs. $7,084; p<0.001) costs. TIO+OLO patients with no exacerbations had significantly lower mean COPD-related total costs ($7,342 vs $16,005; p<0.001) than patients who initiated TT, with lower medical ($3,675 vs. $9,199; p<0.001), and pharmacy ($3,685 vs. $7,032; p<0.001) costs. Among patients in the 'single' exacerbation group, TIO+OLO patients also had lower mean COPD-related total ($8,398 vs. $15,058; p<0.001), medical ($4,954 vs. $8,422; p<0.02) and pharmacy ($3,545 vs. $6,912; p<0.001) costs than TT patients. Among patients in the 'multiple/severe' group, TIO+OLO patients had lower mean COPD-related pharmacy costs ($3,761 vs. $7,249; p<0.001) but no significant difference in total costs ($17,262 vs. 22,979; p=0.1). CONCLUSIONS: Patients initiating TIO+OLO who were either naïve to maintenance treatment, and/or had no or single exacerbations prior to initiation had significantly lower medical and pharmacy costs versus those initiating TT. CLINICAL IMPLICATIONS: This real-world cost analysis illustrates the financial impact of prescribing TT, inconsistent with GOLD recommendations. DISCLOSURES: Employee relationship with Optum Please note: 09/2014 to present Added 05/04/2021 by Amy Anderson, source=Web Response, value=Salary Optum research sponsor relationship with Boehringer Ingelheim Please note: 2017 to current Added 05/04/2021 by Amy Anderson, source=Web Response, value=Research funding to Optum Employee relationship with Optum Please note: 11/2006 to current Added 04/26/2021 by Ami Buikema, source=Web Response, value=Salary Optum research sponsor relationship with Boehringer Ingelheim Please note: 2017 to current Added 04/26/2021 by Ami Buikema, source=Web Response, value=Research funding to Optum Employee relationship with Boehringer Ingelheim Corporation Please note: 2015-2021 Added 04/26/2021 by jess franchino-elder, source=Web Response, value=Salary No relevant relationships by Monica Frazer, source=Web Response no disclosure on file for Lisa Le;Employee relationship with Boehringer Ingelheim Pharmaceuticals, Inc. Please note: 08/07/17 to current Added 04/26/2021 by Swetha Palli, source=Web Response, value=Salary Employee relationship with Boehringer Ingelheim Pharmaceuticals, Inc. Please note: Aug 2017 - Current Added 04/26/2021 by Swetha Palli, source=Web Response, value=Salary

Nursing Research on Patients with Chronic Obstructive Pulmonary Disease and Respiratory Failure Based on Big Data.

This work organically integrates a systematic and individualized nursing plan with big data technology and applies it to the care of patients with chronic obstructive pulmonary disease (COPD) and respiratory failure (RF) and explores the continuous care model based on modern big data technologies to improve COPD and RF. It aims to relieve the symptoms of COPD and RF, reduce the number of acute episodes of COPD and RF and the number of hospitalizations, and improve the quality of life of patients. One hundred COPD and RF patients hospitalized in the respiratory medicine department of a tertiary hospital were selected and were categorized into control and experimental group. The nursing mode of the patients in the control group was the original telephone follow-up in the department, and the contents of the follow-up were determined according to the questions of the patients on the telephone at that time. Based on the original nursing in the department, the experimental group adopted individualized continual nursing plans based on the Internet and big data techniques for patients to conduct a pulmonary rehabilitation-related functional assessment, functional exercise guidance, and health guidance. Experimental results show that, compared with traditional continuous care, individualized continuous care combined with big data techniques can improve the lung function of patients with stable COPD and RF, reduce the number of acute COPD and RF attacks and the number of readmissions, and improve self-management ability and quality of life. The method can be applied and implemented in continuous nursing care.

The Importance of Measuring Troponin in Chronic Obstructive Pulmonary Disease Exacerbations: A Systematic Review.

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Many patients with acute exacerbations need intensive care. There are many cardiovascular risk factors and comorbid conditions linked with COPD. Troponin elevation is used for the diagnosis of myocardial infarction. However, it is commonly elevated in patients with COPD. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Scopus were searched for relevant articles. A total of 383 papers were identified. Out of the 383 papers, only 30 papers remained for final synthesis after removing duplicates, screening for relevant articles, and assessing eligibility criteria. After the quality appraisal, 11 papers were chosen for inclusion in this study. COPD is characterized by obstruction and inflammation of the airways. It is caused mainly by smoking, by causing harmful changes in the structure of the airways. It usually presents with dyspnea, cough, and/or production of sputum. Troponins are regulatory proteins found in the myocardium and skeletal muscles. The cause of its elevation in COPD and acute exacerbated chronic obstructive pulmonary disease (AECOPD) remains unclear. However, several reasons and factors have been suggested. The most intriguing fact is that high troponin in COPD, especially in exacerbations, has been linked in many articles to a higher risk of death. Furthermore, it could serve as a tool for better assessment and management of COPD patients. We found that troponin predicts death and poor outcomes in COPD and AECOPD. The exact mechanism of its elevations is not clear. We believe it can be a valuable tool for clinicians in better managing COPD and assessing the severity of the exacerbations.

Computed Tomography Images under Iterative Reconstruction Algorithm in Analysis of the Efficacy of Honey-Fried Herba Ephedrae along with Western Medicine on Acute Exacerbation Chronic Obstructive Pulmonary Disease

To explore the application value of the reconstruction algorithm based on an iterative algorithm in the analysis of CT image and analyze the therapeutic effect of honey-fried Herba Ephedrae combined with Western medicine on acute exacerbation chronic obstructive pulmonary disease (AECOPD), a total of 96 AECOPD patients admitted to our hospital from January 2018 to December 2019 were selected as research subjects. According to a different treatment method, the subjects were divided into a control group (Ctrl group, conventional therapy) and an observation group (OG, conventional therapy + honey-fried Herba Ephedrae), with 48 in each group. The CT image algorithm was established based on the iterative algorithm, and the CT dose indexes of the reconstruction algorithm and the Filtered Back Projection (FBP) algorithm under the same conditions were compared ( P &lt; 0.05 ). After using CT to confirm the diagnosis of the subjects, the difference in indicators of forced expiratory volume in one second (FEV1), forced expiratory volume in one second to forced vital capacity ratio (FEV1%), and forced vital capacity (FVC), inflammatory factors of serum interleukin-8 (IL-8), serum interleukin-10 (IL-10), and tumor necrosis factor (TNF-α), the bronchial wall area, and the total treatment efficiency before and after different treatment was analyzed. The results suggested that the Computed Tomography Dose Index (CTDI) of iterative reconstruction (IR) algorithm when scanning different parts was higher than that of the FBP algorithm. The pulmonary function indexes and the expression of IL-8 and TNF-α in the OG were higher than those in the Ctrl group ( P &lt; 0.05 ); the bronchial wall area, bronchial wall area percentage, and IL-10 expression in the OG were all lower than those in the Ctrl group ( P &lt; 0.05 ). The effectiveness and improvement rates of the Ctrl group were 47.92% and 25%, respectively, significantly lower than those in the OG group, 56.25% and 31.25% ( P &lt; 0.05 ), and the total efficiency of the observation group was 87.5%, which was significantly higher than that in the Ctrl group (72.92%) ( P &lt; 0.05 ). In conclusion, based on the iterative algorithm, a CT reconstruction algorithm with better noise reduction performance was established, and the use of honey-fried Herba Ephedrae combined with Western medicine can improve the effective rate of treatment.