Acute Exacerbation Of Chronic Obstructive Pulmonary Disease Patients Research Articles

The prevalence and clinical features of pulmonary embolism in patients with AE-COPD: A meta-analysis and systematic review.

BackgroundThe prevalence of pulmonary embolism (PE) in the acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) is highly controversial. We conducted a systematic review and meta-analysis to summarize the epidemiology and characteristics of PE with AE-COPD for current studies.MethodsWe searched the PubMed, EMBASE, Cochrane Library and Web of Science databases for studies published prior to October 21, 2020. Pooled proportions with 95% confidence intervals (95% CIs) were calculated using a random effects model. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals were used as effect measures for dichotomous and continuous variables, respectively.ResultsA total of 17 studies involving 3170 patients were included. The prevalence of PE and deep vein thrombosis (DVT) in AE-COPD patients was 17.2% (95% CI: 13.4%-21.3%) and 7.1% (95% CI: 3.7%-11.4%%), respectively. Dyspnea (OR = 6.77, 95% CI: 1.97–23.22), pleuritic chest pain (OR = 3.25, 95% CI: 2.06–5.12), lower limb asymmetry or edema (OR = 2.46, 95% CI:1.51–4.00), higher heart rates (MD = 20.51, 95% CI: 4.95–36.08), longer hospital stays (MD = 3.66, 95% CI: 3.01–4.31) were associated with the PE in the AE-COPD patients. Levels of D-dimer (MD = 1.51, 95% CI: 0.80–2.23), WBC counts (MD = 1.42, 95% CI: 0.14–2.70) were significantly higher and levels of PaO2 was lower (MD = -17.20, 95% CI: -33.94- -0.45, P<0.05) in the AE-COPD with PE group. The AE-COPD with PE group had increased risk of fatal outcome than the AE-COPD group (OR = 2.23, 95% CI: 1.43–3.50).ConclusionsThe prevalence of PE during AE-COPD varies considerably among the studies. AE-COPD patients with PE experienced an increased risk of death, especially among the ICU patients. Understanding the potential risk factors for PE may help clinicians identify AE-COPD patients at increased risk of PE.Prospero registration numberCRD42021226568.

Effect of sitting and lying Liuzijue exercise for pulmonary rehabilitation in acute exacerbation of chronic obstructive pulmonary disease patients with non-invasive ventilation: a randomized controlled trial.

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) will lead to the aggravation of respiratory symptoms and accelerate the progression of the disease. So early pulmonary rehabilitation is essential for patients with AECOPD. We aimed to investigate the effect of sitting and lying Liuzijue in AECOPD patients with non-invasive ventilation. A total of 80 AECOPD patients with non-invasive ventilation were randomly divided into two groups. The controlled group (CG) (n=40) received AECOPD conventional treatment and nursing, and the sitting and lying Liuzijue exercise group (LG) (n=40) received sitting and lying Liuzijue therapy. Participants in the LG were required to take this training for 3 months, 30 minutes once every morning and evening. Pulmonary function test, 6-minute walking test (6MWT), Modified Medical Research Council Dyspnea Scales (mMRC), and the St George's Respiratory Questionnaire (SGRQ) were evaluated before and after the intervention. Blood gas was measured before treatment, 3 days, and 5 days after treatment. In addition, the length of hospital stay, the duration of non-invasive ventilation, and the frequency of acute exacerbation within 6 months after the intervention were compared. Seventy patients completed the study. The pulmonary function, 6MWT, mMRC scores, SGRQ, and pH, were significantly improved in the LG. Meanwhile, the 6MWT of the CG was improved. The comparison between the groups showed that the improvement of the pulmonary function, 6MWD, mMRC scores, SGRQ, the duration of non-invasive ventilation, and the frequency of acute exacerbation within 6 months of the LG group differed significantly from the CG. Sitting and lying Liuzijue exercise methods significantly improved lung function, exercise endurance, and quality of life in AECOPD patients with non-invasive ventilation. Chinese Clinical Trial Registry ChiCTR2000034530.

Contribution of dipeptidyl peptidase 4 to non-typeable Haemophilus influenzae-induced lung inflammation in COPD.

Dipeptidyl peptidase 4 (DPP4) expression is increased in the lungs of chronic obstructive pulmonary disease (COPD). DPP4 is known to be associated with inflammation in various organs, including LPS-induced acute lung inflammation. Since non-typeable Haemophilus influenzae (NTHi) causes acute exacerbations in COPD patients, we examined the contribution of DPP4 in NTHi-induced lung inflammation in COPD. Pulmonary macrophages isolated from COPD patients showed higher expression of DPP4 than the macrophages isolated from normal subjects. In response to NTHi infection, COPD, but not normal macrophages show a further increase in the expression of DPP4. COPD macrophages also showed higher expression of IL-1β, and CCL3 responses to NTHi than normal, and treatment with DPP4 inhibitor, diprotin A attenuated this response. To examine the contribution of DPP4 in NTHi-induced lung inflammation, COPD mice were infected with NTHi, treated with diprotin A or PBS intraperitoneally, and examined for DPP4 expression, lung inflammation, and cytokine expression. Mice with COPD phenotype showed increased expression of DPP4, which increased further following NTHi infection. DPP4 expression was primarily observed in the infiltrated inflammatory cells. NTHi-infected COPD mice also showed sustained neutrophilic lung inflammation and expression of CCL3, and this was inhibited by DPP4 inhibitor. These observations indicate that enhanced expression of DPP4 in pulmonary macrophages may contribute to sustained lung inflammation in COPD following NTHi infection. Therefore, inhibition of DPP4 may reduce the severity of NTHi-induced lung inflammation in COPD.

A Feasibility and Efficacy Randomized Controlled Trial of Two Exercise Programs in Severe AECOPD Patients with Resting Hypoxemia.

Resting hypoxemia is the most severe stage of Chronic Obstructive Pulmonary Disease (COPD). Due to their impairments during the exacerbation, these patients are limited to traditional exercise rehabilitation and are excluded from the majority of the studies. The aim of this study was to assess the feasibility and the efficacy of two exercise programs in Acute Exacerbation of COPD (AECOPD) patients with resting hypoxemia. In this randomized clinical trial, patients hospitalized due to an acute exacerbation of COPD with hypoxemia at rest were included. Patients were randomly assigned into three groups. A Control Group (pharmacological treatment), a Global Exercise Group (GEG), and a Functional Electrostimulation Group (FEG). Patients were treated during the hospitalization period. The main outcomes were lower limb strength (assessed by a dynamometer), balance (assessed by the one leg standing balance test), health related quality of life (assessed by the EQ-5D), adverse events and adherence. At the end of the intervention, there were significant differences in all the variables in favour of the experimental groups (p < 0.05). We concluded that conducting an exercise program is feasible and improves lower limb strength, balance, and health related quality of life in AECOPD patients with resting hypoxemia.

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.

The Neutrophil/Lymphocyte Ratio Could Predict Noninvasive Mechanical Ventilation Failure in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Retrospective Observational Study.

PurposeTo determine the effectiveness of neutrophil/lymphocyte ratio (NLR), compared to traditional inflammatory markers, for predicting noninvasive mechanical ventilation (NIMV) failure in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients.Patients and MethodsWe conducted this retrospective observational study including 212 AECOPD patients who required NIMV during hospitalization from January 2015 to December 2020 in the department of respiratory and critical care medicine of Beijing Chao-Yang Hospital (west campus). We reviewed the medical record to determine if NIMV succeeded or failed for each patient, and compared NLR with traditional markers (leukocyte, C-reactive protein [CRP] and procalcitonin [PCT]) between NIMV failure and NIMV success group. Receiver-operating characteristic (ROC) curve and multivariate logistic regression analysis were used to assess the accuracy of these markers for predicting NIMV failure.ResultsA total of 38 (17.9%) patients experienced NIMV failure. NLR was a more sensitive biomarker to predict NIMV failure (AUC, 0.858; 95% CI 0.785–0.931) than leukocyte counts (AUC, 0.723; 95% CI 0.623–0.823), CRP (AUC, 0.670; 95% CI 0.567–0.773) and PCT (AUC, 0.719; 95% CI 0.615–0.823). There was statistically positive correlation between NLR and leukocytes count (r=0.35, p<0.001), between NLR and CRP (r=0.258, p<0.001), between NLR and PCT (r=0.306, p<0.001). The cutoff value of NLR to predict NIMV failure was 8.9 with sensitivity 0.688, specificity 0.886 and diagnostic accuracy 0.868. NLR>8.9 (odds ratio, 10.783; 95% CI, 2.069–56.194; P=0.05) was an independent predictor of NIMV failure in the multivariate logistic regression model.ConclusionNLR may be an effective marker for predicting NIMV failure in AECOPD patients, and the patients with NLR>8.9 should be handled with caution since they are at higher risk of NIMV failure and require intubation. Further study with a larger sample size and with more data is necessary to confirm our study.

“RESPIRATORY VIRAL INFECTION: AN UNDERRATED ENTITY THAT NEED TO CONSIDER IN MANAGEMENT OF ACUTE EXACERBATION OF COPD”

BACKGROUND: Acute exacerbation of COPD (AECOPD) is one of the most common cause of hospital admission. It causes signicant morbidity, mortality and inexorable decline in ling function. Many exacerbations are believed to be due to upper and/ lower respiratory tract viral infections, but the incidence of these infections in patients with COPD is still undetermined. Objectives of the study are-(a) To nd out the viral etiology in patients having acute exacerbation of COPD. (b) To correlate the severity of COPD patients having exacerbations with viral etiology. METHODS: This cross-sectional study was carried out on 70 AECOPD patients admitted in department of Respiratory Medicine, Institute of Respiratory Diseases, SMS Medical College, Jaipur during July 2019–June 2020. Demographic and clinical parameters were recorded from each patient during admission. Twin nasopharyngeal/oropharyngeal swabs were collected and are tested for Respiratory viruses via RT-PCR. RESULTS: Respiratory viruses were detected in 15 of 70 (21.42%) patients during exacerbations of COPD. The viruses detected were inuenza (10%), rhinovirus (5.71%), adenovirus (4.29%) and RSV (1.42%). Majority of the patients had exacerbations in severe COPD subgroup, had duration of hospital stay of more than or equal to 5 days, had one episode of acute exacerbation per year and 5, 9, 11 respiratory viruses were detected in this group respectively. CONCLUSION: Viral infections seem to contribute to the exacerbations of COPD in our settings and should be strongly considered in the management of such patients. Considering appropriate antiviral therapy can timely reduce morbidity in an event of an inuenza viral exacerbation.

Systemic Corticosteroids and the Risk of Venous Thromboembolism in Patients with Severe COPD: A Nationwide Study of 30,473 Outpatients.

Due to frequent exacerbations, many patients with chronic obstructive pulmonary disease (COPD) are exposed to oral corticosteroids (OCS), which may be thrombogenic. We evaluated the risk of hospitalisation with venous thromboembolism (VTE) and death in patients with acute exacerbation of COPD (AECOPD) treated with long and short OCS regimens. In this nationwide cohort study of 30,473 COPD outpatients treated for AECOPD, we compared the risk of VTE hospitalisation and all-cause mortality within 6 months in OCS dose of >250 mg vs. ≤250 mg. A multivariable Cox proportional hazard regression was used to estimate the risk. The incidence of VTE hospitalisations was 0.23%. A long OCS treatment course was associated with an increased risk of VTE compared to a short course (hazard ratio (HR) 1.69, [95% confidence interval (CI) 1.05 to 2.72], p < 0.031). A higher risk of all-cause mortality was seen in the group of COPD patients treated with a long OCS course (HR 1.71, [95% CI 1.63 to 1.79], p < 0.0001). The risk of reported VTE hospitalisation was higher among AECOPD patients treated with long courses of OCS, but the absolute risk was low, suggesting under-reporting of the condition.

N-TERMINAL PRO BRAIN NATRIURETIC PEPTIDE: A POTENTIAL PREDICTOR FOR INTENSIVE CARE ADMISSIONS IN PATIENTS WITH ACUTE EXACERBATION OF COPD.

BACKGROUND: Cardiovascular disease is one of the major causes of mortality and is frequently unrecognized in COPD patients. Serum N-terminal pro-brain natriuretic peptide (NT-pro BNP) is an established risk factor in patients with Heart failure. However NT-pro BNP levels may also be elevated during acute exacerbation of COPD(AECOPD) even without heart failure. Objectives of the study are-(a)To nd the levels of Serum NT-pro BNP in AECOPD patients. (b) To nd out the association of Serum NT-pro BNP with clinical and physiological parameters in AECOPD patients. METHODS: This cross-sectional study was carried out on 60 AECOPD patients admitted in department of Respiratory Medicine, Institute of Respiratory Diseases, SMS Medical College, Jaipur during July 2019–June 2020. Clinical data including vitals, Electrocardiogram (ECG), arterial blood gas analysis (ABG), Serum NT-pro BNP levels were assessed. Previous ECG and spirometry details were also recorded. RESULTS: The mean levels of Serum NT-pro BNP were higher in very severe COPD patients. The association of Serum NT-pro BNP were signicantly higher with AECOPD patients having increased exacerbations per year, longer hospital stay duration, decreasing Spo2 levels and decreasing blood pH levels. CONCLUSION: Patients with AECOPD who had elevated Serum NT-pro BNP levels had higher likelihood of ICU admission and longer hospital stay. Thus elevated NT-pro BNP levels warrants the need of Intensive care for early and better management of COPD patients.

Construction and validation of risk prediction model for deep vein thrombosis in acute exacerbations of chronic obstructive pulmonary disease based on serum angiopoietin 2 levels.

This study aims to establish a predictive risk model for deep vein thrombosis (DVT) in patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) based on serum angiopoietin 2 (Ang-2) levels. The research sample consisted of 650 patients with AECOPD admitted to the First Affiliated Hospital of Chengdu Medical College from January 2019 to January 2021, who were subsequently divided into a modeling group and a verification group. A univariate analysis was performed on the identified risk factors for DVT in AECOPD, and the significant factors were then incorporated into a multivariate logistic regression model to screen for the independent predictors of DVT. A nomogram was constructed, and a receiver operating characteristic curve (ROC), Hosmer-Lemeshow test, decision curve, and clinical impact curve in the modeling and validation cohort were used to analyze the discrimination power, calibration, and clinical validity of the predictive risk nomogram model of AECOPD with comorbid DVT. Univariate and multivariate logistic regression analyses showed that lower limb edema, BMI, diabetes, respiratory failure, D-dimer, and serum Ang-2 were risk factors for DVT in AECOPD. A nomogram model for predicting AECOPD with comorbid DVT was successfully established. The AUC values for the modeling group and the verification group were 0.844 (95% CI: 0.808-0.932) and 0.755 (95% CI: 0.679-0.861), respectively. According to the Hosmer-Lemeshow test, the P values of the nomogram in the modeling group and the verification group were 0.124 and 0.086, respectively. The decision curve and clinical impact curve suggested that most patients can benefit from this prediction model, and the predicted probability of the model was essentially the same as the actual clinical probability of DVT. The predictive risk nomogram model of AECOPD with comorbid DVT based on serum Ang-2 levels has good discrimination power, calibration, and clinical influence. The model is a good fit and has a high predictive value, which helps clinicians identify AECOPD patients at high risk of DTV and formulate corresponding prevention and treatment measures.

The Impact of COVID-19 on Hospitalised COPD Exacerbations in Malta.

Method Data was collected retrospectively from electronic hospital records during the periods 1st March until 10th May in 2019 and 2020. Results There was a marked decrease in AECOPD admissions in 2020, with a 54.2% drop in admissions (n = 119 in 2020 vs. n = 259 in 2019). There was no significant difference in patient demographics or medical comorbidities. In 2020, there was a significantly lower number of patients with AECOPD who received nebulised medications during admission (60.4% in 2020 vs. 84.9% in 2019; p ≤ 0.001). There were also significantly lower numbers of AECOPD patients admitted in 2020 who received controlled oxygen via venturi masks (69.0% in 2020 vs. 84.5% in 2019; p = 0.006). There was a significant increase in inpatient mortality in 2020 (19.3% [n = 23] and 8.4% [n = 22] for 2020 and 2019, respectively, p = 0.003). Year was found to be the best predictor of mortality outcome (p = 0.001). The lack of use of SABA pre-admission treatment (p = 0.002), active malignancy (p = 0.003), and increased length of hospital stay (p = 0.046) were also found to be predictors of mortality for AECOPD patients; however, these parameters were unchanged between 2019 and 2020 and therefore could not account for the increase in mortality. Conclusions There was a decrease in the number of admissions with AECOPD in 2020 during the COVID-19 pandemic, when compared to 2019. The year 2020 proved to be a significant predictor for inpatient mortality, with a significant increase in mortality in 2020. The decrease in nebuliser and controlled oxygen treatment noted in the study period did not prove to be a significant predictor of mortality when corrected for other variables. Therefore, the difference in mortality cannot be explained with certainty in this retrospective cohort study.

ILC2 Cells Promote Th2 Cell Differentiation in AECOPD Through Activated Notch-GATA3 Signaling Pathway.

This study is to investigate the capacity of type 2 innate lymphoid cells (ILC2s) in regulating the Th2 type adaptive immune response of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The study enrolled healthy people, stable chronic obstructive pulmonary disease (COPD) patients, and AECOPD patients. Flow cytometry was used to detect Th2 and ILC2 cells in the peripheral blood. In addition, ILC2s from the peripheral blood of AECOPD patients were stimulated with PBS, IL-33, Jagged1, DAPT, IL-33+Jagged1, IL-33+DAPT, and IL-33+Jagged-1+DAP in vitro. The levels of cytokines in the culture supernatant were detected by ELISA and the culture supernatant was used to culture CD4 + T cells. The mRNA and protein levels of Notch1, hes1, GATA3, RORα, and NF-κB of ILC2s were detected by real-time PCR and Western blot. The proportion of Th2 and ILC2s was significantly increased in the peripheral blood of AECOPD patients, alone with the increased Notch1, hes1, and GATA3 mRNA levels. In vitro results showed that the mRNA and protein levels of Notch1, hes1, GATA3 and NF-κB were significantly increased after stimulation with Notch agonist, meanwhile, the level of type 2 cytokines were increased in the supernatant of cells stimulated with Notch agonist, and significantly promoted differentiation of Th2 cells in vitro. Disruption of Notch pathway weakened GATA3 expression and cytokine production, and ultimately affected the differentiation of Th2 cells. In conclusion, our results suggest that ILC2s can promote Th2 cell differentiation in AECOPD via activated Notch-GATA3 signal pathway.

A risk-predictive model for invasive pulmonary aspergillosis in patients with acute exacerbation of chronic obstructive pulmonary disease

ObjectivesInvasive pulmonary aspergillosis (IPA) is increasingly reported in chronic obstructive pulmonary disease (COPD) patients. These patients often have poor clinical outcomes. Early recognition of IPA in COPD is always challenging. We aimed to develop and validate a risk model using readily available clinical parameters to predict IPA for acute exacerbation of COPD (AECOPD) patients.MethodsWe performed a retrospective cohort study. AECOPD patients who were admitted to Jinling Hospital between January 2012 and December 2017 were included. 880 AECOPD patients were randomly divided into the training set (70%, n = 616) and validation set (30%, n = 264). A nomogram model was developed using multivariate logistic regression from training set. The discrimination and calibration of model were validated internally. Decision curve analyses assessed the clinical utility of the nomogram.ResultsThe incidence of IPA in hospitalized AECOPD patients was 9.6% in the training set (59 cases of IPA) and 9.1% in the validation set (24 cases of IPA), respectively. The nomogram model consisted of independent factors associated with IPA included lung function GOLD III–IV, use of broad-spectrum antibiotic over 10 days in the last month, oral or intravenous corticosteroids (prednisone) over 265 mg in the last 3 months and serum albumin < 30 g/L. The model performed good discrimination and calibration in validation set (c-statistic, 0.79 [95%CI 0.68–0.90]). The 95%CI region of calibration belt did not cross the 45-degree diagonal bisector line (P = 0.887).ConclusionThe simple risk predictive model for earlier recognition of IPA is useful in hospitalized AECOPD patients.

Eosinophilic phenotype was associated with better early clinical remission in elderly patients but not middle-aged patients with acute exacerbations of COPD.

There is limited evidence of the relationship between peripheral blood eosinophils and clinical remission of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) at different ages, especially in elderly patients, which was the objective of the present study. This retrospective study stratified patients by age (elderly patients >65years old or middle-aged patients between 45 and 65years old) and analysed the relationship between blood eosinophils (≥2% or <2%) and AECOPD clinical remission at observing time points of 7, 14, 21 and 28days of hospitalisation. Student's t tests, Mann-Whitney U tests, Chi-squared or Fisher's exact tests were conditionally used to compare difference between groups. The unadjusted or adjusted Cox proportional hazards model was used to analyse the association between blood eosinophilic levels and cumulative clinical remission. Of 703 AECOPD cases analysed, 616 were elderly people (>65years), 312 of whom had eosinophilic exacerbations. There were statistically significant differences in leucocytes, eosinophils, neutrophils, lymphocytes, monocytes, high-sensitivity C-reactive protein levels (hs-CRP), and hospital costs between groups (P<.05, respectively). According to the chi-square analysis, eosinophilic exacerbation had a higher clinical remission rate at 7, 14 and 21days (all P<.05), but not 28days (P>.05). Among analysis through adjusted Cox proportional hazards model, eosinophilic exacerbation was significantly associated with a higher cumulative remission rate in elderly patients at 7, 14, 21days (all P<.05), but not 28days (P>.05). No significant association was observed in meddle-aged patients at any time points (all P>.05). Eosinophilic exacerbation was associated with better early clinical remission of AECOPD patients during hospitalisation. As stratified by ages, similar results were observed in elderly patients but not middle-aged patients. Blood eosinophils at different ages may be valuable in personalised management for AECOPD.

Real-world antibiotic use in treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in China: Evidence from the ACURE study.

Background: The evidence for real-world antibiotic use in treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is insufficient. This study aimed to investigate real-world antibiotic use in the management of AECOPD in China. Methods: All hospitalized AECOPD patients from the acute exacerbation of chronic obstructive pulmonary disease inpatient registry (ACURE) study conducted at 163 sites between January 2018 and December 2019 were screened according to the eligible criteria. The eligible study population was divided into secondary and tertiary hospital groups. Patients’ baseline characteristics, antibiotic use, and bacterial pathogen characteristics were retrieved and analyzed using SPSS 23.0. Results: A total of 1663 patients were included in the study, including 194 patients from secondary hospitals and 1469 patients from tertiary hospitals. Among the 1663 AECOPD patients enrolled, 1434 (86.2%) received antibiotic treatment, comprising approximately 85.6% and 86.3% of patients in the secondary and tertiary hospital groups, respectively. The median antibiotic therapy duration was 9.0 (interquartile range [IQR]: 7.0 - 11.0)°days. Regarding the routes of antibiotic use, 1400 (97.6%) patients received intravenous antibiotics, 18 (1.3%) patients received oral antibiotics, 15 (1.0%) patients received both intravenous and oral antibiotics, and one (0.1%) patient received both oral and nebulized antibiotic treatment. In addition, cephalosporin, penicillin, and quinolone were the most commonly prescribed antibiotics (43.6%, 37.0%, and 34.2%, respectively). In total, 990 (56.5%) patients underwent pathogen examinations; the proportion of patients receiving pathogen examinations in the second hospital group was significantly lower than that in the tertiary hospital group (46.4% vs 61.3%, p < 0.001). Conclusion: This study demonstrates that an antibiotic overuse may exist in the treatment of AECOPD in China. Measures should be taken to prevent the overuse of antibiotics and potential antimicrobial resistance (AMR) in Chinese AECOPD patients.

English

BACKGROUND Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, and causes significant morbidity. Cardiovascular compromise is often associated with COPD, especially in acute exacerbations. The purpose of this study is to find out the incidence of elevation of troponin I levels in acute exacerbation of COPD patients and measuring the outcome in terms of need for ventilation (both invasive and non-invasive), length of hospital stay &amp; mortality. METHODS This was a prospective analytical study done on 30 patients with acute exacerbation of COPD who were admitted in Government Mohan Kumaramangalam Medical College and Hospital, Salem, Tamil Nadu from December 2015 to June 2016. Troponin I levels were estimated for all patients on admission. A cut off value of more than 34.2 pg/ml was considered as elevation. A written informed consent was obtained. Clinical outcomes were studied by doing echocardiogram to measure the pulmonary artery systolic pressures (PASP), the need for mechanical ventilation (both invasive and non-invasive), length of stay in the hospital and mortality. RESULTS The pulmonary artery systolic pressures were 52 mm of Hg vs 40.3 mm Hg (P &lt; 0.002), length of hospital stay was 9.67 vs 6.63 days (P &lt; 0.027), patients who required ventilatory support were 13 out of the 30 and the mean duration of ventilation was higher in troponin I elevated patients 5.67 vs 3.57 days (P &lt; 0.0015) and mortality was higher in patients with increased troponin I levels (2 deaths) when compared to patients with normal troponin I levels (1 death)and is statistically significant (P &lt; 0.001). CONCLUSIONS There was a significant elevation of troponin I in acute exacerbation COPD patients. Our study concluded that the presence of elevated levels of troponin I in acute exacerbation of COPD is associated with increased morbidity in terms of increased need for mechanical ventilation, intensive care unit (ICU) stay and mortality. KEYWORDS Cardiac Biomarker, NIV, PASP, Troponin I

Prognostic marker for severe acute exacerbation of chronic obstructive pulmonary disease: analysis of diffusing capacity of the lung for carbon monoxide (DLCO) and forced expiratory volume in one second (FEV1)

BackgroundIt is important to assess the prognosis of patients with chronic obstructive pulmonary disease (COPD) and acute exacerbation of COPD (AECOPD). Recently, it was suggested that diffusing capacity of the lung for carbon monoxide (DLCO) should be added to multidimensional tools for assessing COPD. This study aimed to compare the DLCO and forced expiratory volume in one second (FEV1) to identify better prognostic factors for admitted patients with AECOPD.MethodsWe retrospectively analyzed 342 patients with AECOPD receiving inpatient treatment. We classified 342 severe AECOPD patients by severity of DLCO and FEV1 (≤ vs. > 50% predicted). We tested the association of FEV1 and DLCO with the following outcomes: in-hospital mortality, need for mechanical ventilation, need for intensive care unit (ICU) care. We analyzed the prognostic factors by multivariate analysis using logistic regression. In addition, we conducted a correlation analysis and receiver operating characteristic (ROC) curve analysis.ResultsIn multivariate analyses, DLCO was associated with mortality (odds ratio = 4.408; 95% CI 1.070–18.167; P = 0.040) and need for mechanical ventilation (odds ratio = 2.855; 95% CI 1.216–6.704; P = 0.016) and ICU care (odds ratios = 2.685; 95% CI 1.290–5.590; P = 0.008). However, there was no statistically significant difference in mortality rate when using FEV1 classification (P = 0.075). In multivariate linear regression analyses, DLCO (B = − 0.542 ± 0.121, P < 0.001) and FEV1 (B = − 0.106 ± 0.106, P = 0.006) were negatively associated with length of hospital stay. In addition, DLCO showed better predictive ability than FEV1 in ROC curve analysis. The area under the curve (AUC) of DLCO was greater than 0.68 for all prognostic factors, and in contrast, the AUC of FEV1 was less than 0.68.ConclusionDLCO was likely to be as good as or better prognostic marker than FEV1 in severe AECOPD.

An Integrative Transcriptomic and Metabolomic Study Revealed That Melatonin Plays a Protective Role in Chronic Lung Inflammation by Reducing Necroptosis.

It has been reported that melatonin can relieve the symptoms of chronic obstructive pulmonary disease (COPD) by improving sleep quality, that is to say, the pineal secreted hormone melatonin has a protective effect in the pathogenesis of COPD, but its underlying mechanism remains unclear. In this study, we recruited 73 people into control (n = 22), stable COPD (n = 20), and acute exacerbation of COPD (n = 31) groups to detect the serum melatonin levels. Then, through the mouse model, we employed a systematic study based on the metabolomic and transcriptomic analyses to investigate the molecular mechanisms involved in the progression of the disease. Circulating melatonin in acute exacerbation of COPD patients was decreased compared with that in healthy donors and stable COPD patients. The serum melatonin level was positively correlated with lung function parameters, such as FEV1, FEV1/FVC, and FEV1% predicted in acute exacerbation of COPD patients. Animal experiments showed that melatonin can not only alleviate chronic lipopolysaccharide (LPS)-induced mouse lung destruction and chronic lung inflammation but also reduce necroptosis (RIP1/RIP3/MLKL), a programmed cell death process in bronchial epithelial cells. The protective effect of melatonin on chronic lung inflammation was further suggested to be dependent on targeting its membrane receptor MT1/MT2. In addition, transcriptomic and metabolomic profiling in the lungs of mice indicated that LPS can induce perturbations of the mainstream metabolites associated with amino acid and energy metabolism. Melatonin may reduce the necroptosis by modifying the disordered pathways of alanine, aspartate, and glutamate metabolism caused by LPS. This study suggests that melatonin may act as a potential therapeutic agent for alleviating the chronic inflammation associated with COPD.

Forecast the Exacerbation in Patients of Chronic Obstructive Pulmonary Disease with Clinical Indicators Using Machine Learning Techniques.

Preventing exacerbation and seeking to determine the severity of the disease during the hospitalization of chronic obstructive pulmonary disease (COPD) patients is a crucial global initiative for chronic obstructive lung disease (GOLD); this option is available only for stable-phase patients. Recently, the assessment and prediction techniques that are used have been determined to be inadequate for acute exacerbation of chronic obstructive pulmonary disease patients. To magnify the monitoring and treatment of acute exacerbation COPD patients, we need to rely on the AI system, because traditional methods take a long time for the prognosis of the disease. Machine-learning techniques have shown the capacity to be effectively used in crucial healthcare applications. In this paper, we propose a voting ensemble classifier with 24 features to identify the severity of chronic obstructive pulmonary disease patients. In our study, we applied five machine-learning classifiers, namely random forests (RF), support vector machine (SVM), gradient boosting machine (GBM), XGboost (XGB), and K-nearest neighbor (KNN). These classifiers were trained with a set of 24 features. After that, we combined their results with a soft voting ensemble (SVE) method. Consequently, we found performance measures with an accuracy of 91.0849%, a precision of 90.7725%, a recall of 91.3607%, an F-measure of 91.0656%, and an AUC score of 96.8656%, respectively. Our result shows that the SVE classifier with the proposed twenty-four features outperformed regular machine-learning-based methods for chronic obstructive pulmonary disease (COPD) patients. The SVE classifier helps respiratory physicians to estimate the severity of COPD patients in the early stage, consequently guiding the cure strategy and helps the prognosis of COPD patients.

Respiratory Aspergillus Colonization Was Associated With Relapse of Acute Exacerbation in Patients With Chronic Obstructive Pulmonary Disease: Analysis of Data From A Retrospective Cohort Study.

Background: Patients with chronic obstructive pulmonary disease (COPD) are more susceptible to Aspergillus colonization or infection. Several studies have demonstrated that invasive pulmonary Aspergillosis (IPA) and Aspergillus hypersensitivity (AH) have a detrimental effect on COPD. However, it remains to be clarified whether Aspergillus colonization is associated with acute exacerbation of COPD (AECOPD). This study aimed to explore the impact of Aspergillus colonization in the lower respiratory tract on AECOPD.Method: Patients with Aspergillus colonization were identified from a retrospective cohort of hospitalized AECOPD from 2011 to 2016 in eight centers in Shanghai, China. The demographic information, conditions of the stable stage, clinical characteristics during hospitalization, and 1-year follow-up information after discharge were collected and compared to participants without fungi colonization.Result: Twenty-six hospitalized AECOPD patients with Aspergillus colonization and 72 controls were included in the final analysis after excluding patients with other fungi isolation and matching. The rates of recurrence of acute exacerbation within 90 days and 180 days after discharge in the patients with Aspergillus colonization were both significantly higher than that in the fungi negative patients (90 days: 19.2 vs. 4.2%, p = 0.029; 180 days: 23.1 vs. 4.2%, p = 0.010), and the all-cause mortality within 1 year was also higher (11.5 vs. 0.0%, p = 0.017). Multivariate logistic regression analysis showed that Aspergillus colonization was an independent risk factor for the recurrence of acute exacerbation within 90 days and 180 days (90 days: OR = 8.661, 95% CI: 1.496-50.159, p = 0.016; 180 days: OR =10.723, 95% CI: 1.936-59.394, p = 0.007).Conclusion: Aspergillus colonization may predict poor prognosis of AECOPD while leading to an increased risk of recurrent AECOPD in a short period.